MONTHLY USE FORMS

(to be submitted every 25th to 29th of the Month)

1. INSPECTION AND INVENTORY OF MEDICINE, SUPPLIES, & EQUIPMENT

2. CLINIC AND HEALTH MONTHLY REPORT with AMR

3. KEY PERFORMANCE MEASURE (KPM)  & ATTACHMENT FOR MEDICAL

4. WORK ACCIDENT/INVESTIGATION REPORT (WAIR)

   • • SUBMITTED IS ONLINE. (CLICK HERE)

NOTE: 

DO NOT MAKE EDIT ONLINE, PLEASE DOWNLOAD, AND EDIT ON YOUR PC OR LAPTOP.

OTHER HEALTH FORMS

1. CLINIC ADVISE SLIP

2. PATIENT HEALTH RECORD

3. LACTATION STATION REGISTRY

4. PRE-EMPLOYMENT MEDICAL EXAMINATION (PEME) CERTIFICATE

5. PAGSUNOD SA PAYONG MEDICAL

6. MEDICAL CERTIFICATE - FOR GENERAL USE

7. ALCOHOL TEST CONSENT FORM (English & Tagalog Ver)

8. BLOOD PRESSURE & BLOOD SUGAR MONITORING SHEET

9. LETTER OF AUTHORIZATION (LOA) TO ACCREDITED HOSPITAL

10. RELEASE OF MEDICAL INFORMATION

11. KARDEX

12. MEDICAL INCIDENT REPORT

13. PRESCRIPTION

14. PATIENT'S FEEDBACK SLIP

OTHERS:

1. Sample MEMO - Three-Ten Time - A Little Stretch Goes a Long Way -   📄

2.