I.

Mandate:
The Philippine Heart Center is a government corporation organized and existing under and by virtue of Presidential Decree
No. 673. The institution is committed to save lives and alleviates thousands who suffer from cardiovascular diseases.
II. Vision:
The Philippine Heart Center is the leader in upholding the highest standards of cardiovascular care, a self-reliant institution
responsive to the health needs of the Filipino people by 2022.
III. Mission:
We shall provide comprehensive cardiovascular care enhanced by education and research that is accessible to all.
IV. Service Pledge:
We commit to:
1. Perform service with utmost knowledge and skills keeping in mind the welfare of the general public.
2. Excel in patient care, public information, education and training, and research.
3. Oversee the continuous operations of the institution to fully serve the people in a friendly environment.
4. Provide client awareness through the 24/7 accessibility of the information, education and communication
through our website (www.phc.gov.ph), and reach us through Tel. No. (02) 89252401 up to 50.
5. Lead in the provision of the highest standard of cardiovascular care in the country.
6. Ensure the best service rendered at shortest given time with integrity, compassion and respect.
7. Attend to all applicants or requesting parties who are within the premises of the office prior to the end of official
working hours and during lunch break
 PAGE NO.

PHC MANDATE, VISION, MISSION, SERVICE PLEDGE

LIST OF SERVICES

PART I - MEDICAL SERVICES

EXTERNAL SERVICES
Admission from Emergency Room
Adult Pulmonary Function Test
Ambulance Conduction/Transfer
Angiography
Aprehesis Donation
Application for Medical Staff Membership
Arterial Blood Gas
Blood and Blood Components Procurement
Blood Bank Procedure
Blood Culture and Sensitivity Test
Blood Donor Screening and Donation
Bone densitometry
Bronchoscopy Procedure
Cardiac Health Education, Enhancement & Restoration Service (C.H.E.E.R.S.)
Clearance
Cardiopulmonary Function Test
Claiming of Dead Body
Consultation-Liaison/In-Patient Referral
CT guided biopsy
CT/MRI Procedures (CT Angio, MR Angiogram)
Culture and Sensitivity Test (All specimen except blood)
Diagnostic Packages for Government Agencies
Diagnostic Packages for Out Patients
 PAGE NO.

Discharge of Service Patients at Emergency Room (ER)

Drug Testing
Electrodiagnosis
Electroencephalogram (EEG) Request Process
Electrophysiology Procedures
ER Consulation
Flu, Hepatitis B Vaccination
Forced Oscillation Technique
Fractional Exhaled Nitric Acid (FENO)
General Cardiology Clinics
Histopathological Tests (Surgical and Cytological Tests including FNAB)
Hemodialysis
HIV Testing
Indirect Calometry
Inhalation Therapy
Laboratory Tests
Maintenance of wakefulness Test
Mammography
Medical Consultation from a Physiatrist
Multiple Sleep Latency Test
Neonates and Pediatric Pulmonary Function Test
Non-Invasive Ambulatory Procedures
Non-Invasive Diagnostic Procedures
Nuclear Imaging Procedure
Out-Patient Consultation (Adults)
Pediatric Cardiology Clinics
Pre-flight Assessment Test/Hypoxia Altitude Simulation Test (HAST)
Prescription Refill
Psychiatrist Medical Consultation
 PAGE NO.

Pulmonary Rehabilitation Program

Radio-active Immuno assay (Blood Related Test)
Rehabilitation Services
Rheumatic Fever Prophylaxis (Benzathine Penicillin)
Six Minute Walk Test
Sleep Study (Polysomnography Procedure)
Smoking Cessation Program
Splint Fabrication
Sputum Induction
Ultrasound Procedures
Ultrasound-Guided Biopsy
Venous Bicarbonate Test
Wound Care Clinic
X-ray Procedures

INTERNAL SERVICES
Infirmary Check-up

PART II – NURSING SERVICES

EXTERNAL SERVICES
Discharge of Admitted Service Patients
Dicharge of Private Patients
Purchase of Items Available at Central Supply Services
Purchase of Items Available at Linen Section
Purchase of Linen Items

PART III – HOSPITAL SUPPORT SERVICES

EXTERNAL SERVICES
 PAGE NO.

Admission of Patients -Elective

Approved Contract Releasing
Art Exhibit
Catering Service
Certification of Refund to Patient-Phamacy
Credit Arrangement
Discharge of Z-Benefits In-Patients
Discount on Medicines
Dispensing of Medicine – In-Patients
Dispensing of Medicines to Out-Patient-Annex Bldg.
Dispensing of Medicines to Out-Patient-Satellite
Dispensing of Medicines to Out-Patient with Service Issue Slip
DOH Financial Assistance
Function Rooms' Use – Outsiders
Gate Pass for Equipment – PHC Tenants
Gate Pass for Equipment – Suppliers
Gate Pass for Supplies – Suppliers
Guided-Group-Tour Request (Online)
Guided-Group-Tour Request (Personal)
Hospital Bill Certification – For Discharged Patients
Hospital Bill Payment – In Patient
Hospital Bill Payment – Out Patient
Inter-Agency Referral to other Health Facility
Last Salary Processing
Medical Representative's ID
Medication Counselling by the Clinical Pharmacist
Nutrition Counselling-Out Patient
PCSO (Phil. Charity Sweepstakes Office Assistance Availment
Price Certification Issuance
 PAGE NO.

Psychological Assessment for Applicants

Purchase Order (PO) /Job Order(JO) /Amendment
Recruitment, Appointment, Compensation
Refund of Deposit to Service In Patients
Refund of Excess Deposits/cancelled Out Patient Procedures-not more than
P15,000
Refund of Excess Deposits/cancelled Out Patient Procedures- more than
P15,000
Refund of Excess Payment on Hospital Bills
Refund of Philhealth Benefits
Releasing of Checks to Suppliers and Contractors
Request for Approval – Guarantee Letter(s) - (GLs)
Request for Approval – Inter Agency Networking Referral Services (Referral from
PHC)
Request for Approval – Inter Agency Networking Referral Services (Referral to
PHC)
Request for Discretionary Discount
Request for Financial Assistance (FA)
Resigned/Retired Employees' Benefits
Service Issue Slip (SIS) Issuance
Social Service Assistance at the Emergency Room
Social Service Assistance – In-Patients
Social Service Assistance – Out-patients
Statement of Account (OPD Dialysis Patients with Philhealth Benefits)
Statement of Account (Pay and Company Sponsored In Patients)
Student Affiliation (On-The-Job Training and Work Immersion)
Suppliers' Certificate
Suppliers' Registry Certificate
 PAGE NO.

Telephone Calls

INTERNAL SERVICES
Cafeteria Special Function Request
Car Sticker
Certifications for Various Purposes
Disbursement Voucher for Maternity Pay, SPL for Women, Honorarium, Salary of
Reliever
Dispensing of Medicines to PHC Employee
Doctor's Clinic-Application for space
Dormitory application-PHC Employee
Dormitory application-Transient
Function Rooms' Use – Employees
Gate Pass for Equipment-PHC Employee
Job Order Request-Renovation and Construction of Facilities
Job Order Request-Repair and Maintenance of Equipment anf Facilities
Learning and Development Program
Mutual Benefit Claim
Nutrition Counselling-Employee
Payroll Preparation
Permission to work Part Time
Personnel Records Authenticate Copy
Promotion Procedures
Psychological Assessment for Incoming Fellows/Residents
Public Address
Reimbursement Of Certificate to Employee-Pharmacy
Servicing of Facilities request
Training-Local and Foreign
Vehicle Request
 PAGE NO.

PART IV – EDUCATION, TRAINING ANG RESEARCH SERVICES

EXTERNAL SERVICES
Affiliate Training Program
Application for Continuing Education Programs (Seminars/Updates)
Application for Learning Development Intervention (LDI) Courses for the
Department of Health – Nurse Certification Program (DOH NCP)
Application for Students’ Hospital Affiliation (Graduate Level)
Application for Students’ Hospital Affiliation (Undergraduate Level)
Basic Life Support, Advanced Cardiac Life Support and Pediatric Advanced
Life Support Training Courses
Cardiac Rehabilitation Services
Clinical Trial (1 or 2 site)
Clinical Trials (3 or more sites)
Continuing Education Programs
Executive Check-up Diagnostic Packages
Subspecialty Fellowship, Fellowship and Residency Training
Hypertension and Lipid Clinic Enrolment
Hypertension and Lipid Clinic
Medical Records Services
Non-PHC-Funded Protocol (1-2 site)
Non-PHC-Funded Protocol (3 or more site)
People’s Day Program
PHC-Funded Protocol
Philippine Food and Drug Administration (PFDA)
Post-Graduate Internship Training Rotation
Request for Certificate of Confinement (direct request at the Medical Records
Window)
Request for Certificate of Confinement (forwarded request from the Nursing Unit)
 PAGE NO.

Request for Hospital Guided Tour

Review of Clinical Trials from Outside PHC
Review of Non-House Staff Research Paper
Review of Research Proposals for Fellowship
INTERNAL SERVICES
Availment of Research Grant/Fiancial Assistance for Research Presentation
In-Service Lay Rescuer Cardiopulmonary Resuscitation (CPR), Basic Life
Life Support, Advanced Cardiac Life Support, and Pediatric Advanced Life
Support Training Courses
Request for Patient's Medical Record for Patient Care and Clinic Use
Request for Journal Articles
Request for Patient's Record for Research, Conference, and Gathering of Data
Request for Research of In Patient Statistical Data
Request for Statistical Data Report
Request for Training Certificates
Review of Reserach Proposals

FEEDBACK AND COMPLAINTS MECHANISM

CLIENT SATISFACTION SURVEY
PHILIPPINE HEART CENTER OFFICIALS
Medical Services
External Services
Admission from Emergency Room
Refers to the process by which a patient is admitted from the ER.

Office/Division: Emergency Care/Patient Services Division/Admitting Section

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Patients for emergency admission.

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

If Company sponsored/ with HMO: Company, HMO Coordinator/Liason officer

- Guarantee letter

If with Financial Assistance: Social Service Division, Ground floor, Annex Building
- DOH-MAIP
- Service Issue Slip

- PCSO Guarantee letter

If inmate: Bureau of Jail Management and Penology (BJMP)
- Court Order Bureau of Correctional (BuCor)
- Referral letter from BuCor
- Physician

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present Admission slip from 1. Receive admission slip and issue None 10 minutes Administrative Assistant/Clerk III
Emergency room at Admitting Counter, admitting forms and other documents. Admitting
Ground floor, Hospital Bldg. Section, Ground floor, Hospital
Building
2. Fill out Admitting Form and Submit 2. Receive forms. None 10 minutes Administrative Assistant/Clerk III
admitting forms at Admitting counter. 2.1. Check/verify the accuracy of data. Admitting
2.2 Update data of patient in the Section, Ground floor, Hospital
system. 2.3. Issue Admitting Kit, Patient Building
Satisfaction Survey and Philhealth form.
2.4. Advice patient's relative to go back
to Emergency room.

3. Return to ER and inform Charge 3. Check room if ready for occupancy. None 5 minutes ER Charge Nurse
Nurse of finished transaction at
Admitting Section Emergency Room
Ground Floor, Hospital Building
4. Once room is available, cooperate 4. Prepare all documents and other None 15 minutes Bedside Nurse
during transport to room/unit medical needs of the patient.
Emergency Room
Ground Floor, Hospital Building

Total None 40 mins.

End of Transaction
Adult Pulmonary Function Test
A breathing test to determine lung diseases like bronchial asthma, chronic obstructive lung disease (COPD) and other conditions that
affect breathing.

Office/Division: PULMONARY MEDICINE DIVISION/PULMONARY LABORATORY

Classification: SIMPLE
Type of Transaction G2C & G2G
Who may avail: 19 years old and above
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Doctor's request Attending Physician – Clinic Room
For service patients
 Service OPD card Social Service Division – Annex Bldg.
If payment is through financial assistance/HMO
1. Service Issue Slip (SIS) Social Service Division – Annex Bldg.
2. Health Maintenance Organization (HMO) HMO Coordinator
Letter of Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
1. Present requirements, fill out 1. Receive None 15 Minutes Clerk III
patient data slip and sign Fall requirements Pulmonary Laboratory
Risk Prevention Consent at Reception Area
Pulmonary Laboratory 1.1 Check doctor's
reception, Ground Floor, request
Hospital Bldg.
1.2 Issue patient data
slip

1.3 Interview the client

and give Fall Risk
Prevention Consent
1.4 Instruct patient to
wait for name to be
called
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
2. Cooperate during 2. Get patient height .None 1. For Simple Pulmonary Respiratory Therapist III
performance of the procedure and weight Function Test – 30 Minutes Pulmonary Laboratory PFT
at the Pulmonary Laboratory Area.
PFT area. 2.1 Explain the test 2. For Pulmonary Function
and give proper Test w/ Bronchodilator – 50
instruction. Minutes

2.2 Assist patient in 3. For Pulmonary Function

the performance of Test w/ Lung volume Test – 1
procedure hour and 15 minutes

4. For Pulmonary Function

Test w/ Bronchoprovocation
– 1 hour and 15 minutes

5. For Lung volume Test – 45

minutes

6. For Complete Pulmonary

Function Test – 1 Hour
3. Receive charge slip and pay 3. Issue charge slip *Please see 35 Minutes Clerk III
applicable fees at designated below for table of Pulmonary Laboratory
Cashier area. 3.1 Instruct client to fees Reception Area
*Hospital Lobby, near stairway, pay applicable fees
Monday to Fridays 8 am - 9 pm and to return to
*Basement Cashier – Monday Pulmonary Laboratory
to Sunday 8 am – 7:30 pm reception after
payment
Secure official receipt
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
4. Present official receipt at 4. Receive official None 5 Minutes Clerk III
Pulmonary Laboratory receipt Pulmonary Laboratory
reception area Reception area
4.1 Release initial
copy of the test.
4.2 Instruct client to
claim result after 2
days
5. Present official receipt and Release result None 2 Days Clerk III
claim result at Pulmonary Pulmonary Laboratory
Laboratory reception area on Reception Area
appointed time.
Total Please see below 1. For Simple Pulmonary
for table of fees Function Test – 2 Days 1
Hour 25 Minutes
2. For Pulmonary Function
Test w/ Bronchodilator – 2
Days 1 Hour 45 Minutes
3. For Pulmonary Function
Test w/ Lung volume Test – 2
days 2 hours and 10 minutes
4. For Pulmonary Function
Test w/ Bronchoprovocation
– 2 days 2 hours and 10
minutes
5. For Lung volume Test – 2
days 1 hour and 14 minutes
6. For Complete Pulmonary
Function Test – 2 Days 2
Hours 25 Minutes
End of Transaction
 PROCEDURES PROCEDURE'S FEE READER'S FEE TOTAL

Spirometry Simple / Pulmonary Function Test P 930.00 P 130.00 P 1,060.00

Spirometry Pre and Post Bronchodilator P 1,290.00 P 200.00 P 1,490.00

Spirometry Lung volume studies P 1,050.00 P 150.00 P 1,200.00

Spirometry with Bronchoprovocation P 1,350.00 P 200.00 P 1,550.00

Spirometry DLCO P 2,330.00 P 200.00 P 2,530.00

Spirometry Complete P 3,020.00 P 500.00 P 3,520.00

Ambulance Transfer (Within Metro Manila Only)
Ambulance service that transports patients to and from the Philippine Heart Center.
 
Office/Division: Emergency Care Division
Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Inform Nurse and 1. Process availability of None 20 minutes ER Charge Nurse/Unit Nurse
provide details of transfer ambulance 1.1 Assemble Emergency Room, Ground
and dispatch the ambulance Flr. Hospital Bldg.
team Hospital Units

2. Wait for the availability 2. Process transfer / None 25 minutes ER Charge Nurse
of ambulance and discharge of patient Emergency Room, Ground
cooperate during Flr. Hospital Bldg.
conduction

Total None 45 minutes

End of Transaction

PHILIPPINE HEART CENTER

AMBULANCE FEES
 RATES – AUGUST 1, 2018

No. of Kms. Life Support Ordinary

NAME AND ADDRESS OF HOSPITAL FROM PHC Ambulance Ambulance
(round trip) (FORD)

1 ABM Sison General Hospital 6 P 2,800.00 P 1,700.00

San Miguel Avenue corner Lourdes Road
Ortigas Center, Mandaluyong City

2 Capitol Medical Center 8 3,400.00 2,100.00

Scout Magbanua, Quezon City

3 Cardinal Santos Memorial Hospital 12 4,600.00 2,900.00

Wilson St., San Juan, Metro Manila

4 Chinese General & Medical Hospital 14 5,200.00 3,300.00

286 Blumentritt, Sta. Cruz, Manila

5 De Ocampo Memorial Hospital 15 5,500.00 3,500.00

2921 Nagtahan, Sta. Mesa, Manila

6 Delgado Clinic 7 3,100.00 1,900.00

Kamuning Road, Quezon City

7 Delos Santos General Hospital 10 4,000.00 1,900.00

201 E. Rodriguez Sr., Ave., Quezon City

8 East Avenue Medical Center - Ford 0 2,500.00 1,500.00

East Avenue, Quezon City
9 Family Clinic & Hospital - Ford 13 4,900.00 3,100.00
1474 Ma. Clara St., Manila

10 FEU Hospital 15 5,500.00 3,500.00

Morayta, Manila

11 Infant Jesus Hospital 13 4,900.00 3,100.00

1556 Laong Laan, Manila

12 Las Piñas Doctors Hospital 38 12,400.00 8,100.00

CRM Ave., Las Pinas, Metro Manila

13 Las Piñas General Hospital 38 12,400.00 8,100.00

BF Homes, Las Pinas, Metro Manila

14 Lung Center Of The Philippines 4 2,500.00 1,500.00

Quezon Avenue, Quezon City

15 Makati Medical Center 18 6,400.00 4,100.00

2 Amorsolo St., Makati City

16 Manila Central Univ. (MCU) Hospital 13 4,900.00 3,100.00

Samson Road, Caloocan City

17 Manila Doctors Hospital 17 6,100.00 3,900.00

667 United Nations Ave., Manila

18 Manila Domestic Airport 24 8,200.00 5,300.00

Pasay City

19 Manila Sanitarium & Hospital 20 7,000.00 4,500.00

 1976 Donada St., Pasay City

20 Marianne Doctors Hospital 16 5,800.00 3,700.00

932 United Nations Ave., Manila

21 Martinez Memorial Hospital - Ford 16 5,800.00 3,700.00

198 A. Mabini, Caloocan City

22 Mary Johnston Hospital - Ford 20 7,000.00 4,500.00

1221 Juan Nolasco, Tondo, Manila

23 Medical Center Manila 20 7,000.00 4,500.00

1122 Gen. Luna, Manila

24 Medical City General Hospital 12 4,600.00 2,900.00

Mandaluyong City

25 Metropolitan Hospital 15 5,500.00 3,500.00

1357 G. Masangkay, Manila

26 Mt. Banawe General Hospital 11 4,300.00 2,700.00

62 Quezon Avenue, Quezon City

27 National Children's Medical Center 13 4,900.00 3,100.00

11 Banawe, Quezon City

28 National Kidney Institute 2 2,500.00 1,500.00

East Avenue Medical Center

29 Ninoy Aquino International Airport 27 9,100.00 5,900.00

Pasay City
30 Our Lady of Fatima Hospital 19 6,700.00 4,300.00
120 McArthur Highway, Valenzuela City

31 Our Lady of Lourdes Hospital 14 5,200.00 3,300.00

46 P. Sanchez, Manila

32 Parañaque Community Hospital 29 9,700.00 6,300.00

Old Paranaque, Municipal Bldg.

33 Parañaque Medical Center 30 10,000.00 6,500.00

Dr. A. Santos Ave., Paranaque, Metro Manila

34 Perpetual Help Medical Center 39 12,700.00 8,300.00

Pamplona, Las Pinas, Metro Manila

35 Philippine Children's Medical Center 4 2,500.00 1,500.00

Quezon Avenue, Quezon City

36 Philippine General Hospital 17 6,100.00 3,900.00

Taft Avenue, Manila

37 Polymedic General Hospital 13 4,900.00 3,100.00

163 EDSA, Mandaluyong City

38 Quezon City Medical Center 8 3,400.00 2,100.00

960 Aurora Blvd., Quezon City

39 Quezon Institute 6 2,800.00 1,700.00

E. Jacinto Street, Quezon City

40 Quirino Memorial General Hospital 11 4,300.00 2,700.00

 Katipunan Road, Quezon City

41 San Juan De Dios Hospital 21 7,300.00 4,700.00

2772 Roxas Blvd., Pasay City

42 Singian Memorial Hospital 7 3,100.00 1,900.00

Nicanor Padilla St., Manila

43 St. Jude Medical & Gen. Hospital 14 5,200.00 3,300.00

Dimasalang, Manila

44 St. Luke's Medical Center 10 4,000.00 2,500.00

279 E. Rodriguez Sr., Avenue, Quezon City

45 Sta. Teresita General Hospital 11 4,300.00 2,700.00

100 D. Tuazon Avenue, Quezon City

46 Trinity General Hospital 15 5,500.00 3,500.00

2732 New Panaderos St., Sta. Ana, Manila

47 Trinity Women's and Child Center the Birth Place 15 5,500.00 3,500.00
2732 new Panaderos St., Sta. Ana, Manila

48 UERM Memorial Medical Center 12 4,600.00 2,900.00

Aurora Blvd., Quezon City

49 United Doctors Medical Center 11 4,300.00 2,700.00

6N Ramirez St., Quezon City

50 UST Hospital 13 4,900.00 3,100.00

Espana, Manila
For other places not listed above, basis will be speedometer reading of ambulance. Round trip calculation
should be used in the computation.

Ambulance Fee for first 5 kms or portion thereof P 2,500.00 1,500.00

Ambulance Fee Additional Km. Thereafter 300.00 200.00
Ambulance Fee Waiting Time - For Every 10 Min. Or Portion
Thereof 100.00 100.00

Expendables are to be charged as used in accordance with standard policies.

Angiography
A diagnostic procedure that enables the doctor to see the integrity of the blood vessels of the heart or peripheral vascular system.

Office/Division: Invasive Cardiology Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Patient ID (1 piece)
2. Doctor’s Request Doctor’s Office
3. Green Card (for Service Patient) Out-Patient Division
4. Protime and Creatinine Result, if applicable
If payment is through financial assistance/insurance
1. Guarantee Letter (1 copy) -DOH, PCSO
2. Health Maintenance Organization (HMO) Letter of -HMO Coordinator
Authorization (LOA) (1 copy)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present all necessary 1. Receive requirements and None 10 minutes CVLab Nurse
requirements on scheduled day process registration
and time at Nurse’s Station CV Nurse’s Station CV Lab,
Lab, Ground Floor, Hospital 1.1. Check schedule of Ground Flr. Hospital Bldg.
Building procedure

1.2. Issue consent form and

other applicable documents

2. Fill out and sign applicable 2. Receive consent form and None 10 minutes CVLab Nurse
documents at Nurse’s Station CV applicable documents
Lab, Ground Floor, Hospital Nurse’s Station CV Lab,
Building 2.1. Instruct patient on Ground Flr. Hospital Bldg.
preparation of the procedure

2.2. Instruct relative to

proceed to admitting section
 for Patient Data Sheet

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

3. Fill out Personal Data Sheet 3. Receives Personal Data None 10 minutes Admitting Staff
and other pertinent documents Sheet and other pertinent
located at the Admitting Counter, documents. Ground Floor, Hospital
Ground Floor, Hospital Building Building
3.1. Prepare patient for the
procedure

4. Cooperate during the 4. Assess patient for the None 1 hour and 30 mins CVLab Nurse
procedure procedure
Holding Area, CV Lab,
4.1. Insert IV line Ground Flr. Hospital Bldg.

4.2. Perform requested Angiographer/ CV Lab

procedure. Angiographer Team (Nurse, Med Tech,
performs procedure assisted Rad Tech)
by CV Lab Team (Nurse,
Med Tech, Rad Tech) Nurse’s Station CV Lab,
Ground Flr. Hospital Bldg

6. Proceed to patient’s waiting 6. Monitor patient for post None 30 minutes CVLab Nurse
area after the procedure. CV Lab, procedural reactions.
Ground Floor, Hospital Building Nurse’s Station CV Lab,
6.1. Issue notice of Ground Flr. Hospital Bldg.
Discharge to relative
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

7. Bring notice of discharge to 7. Issue statement of Please see 10 minutes Billing Section, Basement,
Billing and get statement of account, hospital bills, and Procedural charges Medical Arts Building
(Billing Section)
account. professional fee.

Billing Section Basement,

Medical Arts Building

8. Pay hospital bills and 8. Receive Official Receipt of Please see Procedural 30 minutes Cashier, Basement, MAB
professional fee at Cashier’s bills and professional fee and charges
(Cashier Office)
Office Basement, Medical Arts document
Building
8.1. Copy OR number and
8.1. Present official receipt to CV, process patient’s discharge
Nurses Station
8.2. Inform relative/patient
8.2. Present approved Notice of the scheduled date for the
Discharge official result

9. Claim official result at CV Lab 9. Release of Official Result None 2 days CV Lab Clerk, CV Lab
Office, Ground Floor, Hospital Office, Ground Floor,
Building and consult your doctor 9.1. Instruct relative/patient to Hospital Building
for interpretation of results. go back to doctor for
interpretation of result.

Total None 3 days

End of Transaction
 PHILIPPINE HEART CENTER
INVASIVE CARDIOLOGY DIVISION
BASIC LABORATORY RATES

RATES – AUGUST 1, 2018

Excluding materials and medicines needed for each procedure, professional fees and use of machines.
OPD,
Emergency Semi-Private Rooms Private Rooms/
Private Rooms
Room (ER), Including Semi-Private in
SUITE
PROCEDURE Service and Rooms in SICU/MICU/CCU/ SICU/MICU/ ROOMS
Pay Wards PICU/NICU/Isolation Rooms CCU/PICU
1 4 VESSEL ANGIOGRAM 13,100 15,050 17,050 19,000
2 ACT DETERMINATIOM 950 1,100 1,250 1,400
3 AORTOGRAPHY 14,600 16,800 19,000 21,200
4 ASD CLOSURE-DIRECT 24,800 28,500 32,250 35,950
5 ASD CLOSURE W/ HS 29,550 34,000 38,400 42,850
6 BAS 24,150 27,750 31,400 35,000
7 BAS + HS 27,300 31,400 35,500 39,600
8 CORONARY ANGIOGRAPHY (CA) 15,700 18,050 20,400 22,750
9 CA+AORTOGRAPHY 15,850 18,250 20,600 23,000
10 CA+IABI 16,600 19,100 21,600 24,050
11 CA+HS 28,850 33,200 37,500 41,850
12 CA+PTCA+STENT 42,730 49,150 55,550 61,950
13 CA+PTCA+STENT+IABI 48,335 55,585 62,835 70,085
14 CA+PTCA-Direct 33,600 38,640 43,680 48,720
15 CA+4VA 15,700 18,055 20,410 22,765
16 CAROTID ANGIOGRAM 15,650 18,000 20,345 22,695
17 CAROTID STENTING 32,100 36,900 41,750 46,550
18 COIL EMBOLIZATION 14,750 16,950 19,200 21,400
19 FEMORAL ANGIOGRAM 14,650 16,850 19,050 21,250
20 HEMODYNAMIC STUDIES (HS) PLAIN 29,600 34,050 38,500 42,900
21 HS + WITH 02 CHALLENGE 31,400 36,100 40,800 45,550
INTRACRANIAL MECHANICAL
14,850
21a THROMBECTOMY* 17,100 19,300 21,550
22 IVC FILTER INSERTION 14,450 16,600 18,800 20,950
22A LIVER/LUNG ABLATION* 14,850 17,100 19,300 21,550
22B LIVER/LUNG ABLATION CERAMIC* 14,850 17,100 19,300 21,550
23 PDA CLOSURE DIRECT 26,650 30,650 34,650 38,650
24 PDA CLOSURE WITH HS 29,550 34,000 38,400 42,850
25 PERICARDIOCENTESIS 12,900 14,850 16,750 18,700
PERIPHERAL MECHANICAL 14,850
25A THROMBECTOMY* 17,100 19,300 21,550
26 POST BYPASS CA 15,700 18,050 20,400 22,750
27 PPBV PLAIN 27,200 31,300 35,350 39,450
28 PPBV W/ HS 29,550 34,000 38,400 42,850
29 PTBD DRAINAGE 9,250 10,650 12,050 13,400
30 PTCA + STENT 34,100 39,200 44,350 49,450
31 PTCA – DIRECT 33,300 38,300 43,300 48,300
32 PTCRA/ROTABLATION 23,425 26,950 30,450 33,950
33 PTMC PLAIN 27,200 31,300 35,350 39,450
34 PTMC W/ HS 29,550 34,000 38,400 42,850
PULMONARY MECHANICAL 14,850
34A THROMBECTOMY* 17,100 19,300 21,550
14,850
34B PULMONARY MASS EMBOLIZATION* 17,100 19,300 21,550
14,850
34C PROSTATIC ARTERY EMBOLIZATION* 17,100 19,300 21,550
35 RENAL STENTING 22,400 25,750 29,120 32,500
36 SGI 13,650 15,700 17,750 19,800
37 TPI 13,650 15,700 17,750 19,800
38A THYROID ABLATION* 14,850 17,100 19,300 21,550
38 IABI 13,650 15,700 17,750 19,800
39 USE OF IABP PER HOUR 950 1,100 1,250 1,400
39A UTERINE ARTERY EMBOLIZATION* 14,850 17,100 19,300 21,550
39A VEIN ABLATION* 14,850 17,100 19,300 21,550
40 VSD CLOSURE – DIRECT/ PLAIN 27,200 31,300 35,350 39,450
41 VSD CLOSURE W/ HS 29,550 34,000 38,400 42,850
42 AV FISTULA ANGIOPLASTY 14,250 16,400 18,550 20,650
43 02 SATS 600 700 800 850
44 IVUS 13,750 15,800 17,900 19,950
45 CORONARY ANGIOGRAPHY + IVUS 16,000 18,400 20,800 23,200
46 CA+PTCA=STENT+IVUS 38,950 44,800 50,650 56,500
47 PTCA+STENT+IVUS 36,050 41,450 46,850 52,250
48 MESENTRIC ANGIOGRAPHY 15,650 18,000 20,350 22,700
49 PTA AV FISTULA ANGIOPLASTY 14,300 16,450 18,600 20,750
50 PFO CLOSURE 27,200 31,300 35,350 39,450
51 ASD STENTING 22,000 25,300 28,600 31,900
52 PDA STENTING 22,200 25,550 28,850 32,200
53 VASCULAR PLUG 14,300 16,450 18,600 20,750
54 RETRIEVAL OF DEVICE 12,700 14,600 16,500 18,400

* Effective November 8, 2019

Apheresis Donation
This procedure obtains 6-8 units Platelet concentrate and Fresh frozen plasma randomly/single unit collected from blood donor using Apheresis
Machine.

Office/Division: Blood Bank

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None

1. Inquire about blood 1. Explain about Blood None 5 minutes Clerk or Medical
donation /secure and fill Donation and ask approval to Technologist
out Blood Donor's Form undergo Apheresis procedure
(Blood Bank Reception and leaflets on Donor's
Area MAB Annex qualification
Building- Mezzanine, 2nd
Floor Window 14) 1.1 Issue blood donor form and
assist blood donor in filling out
of form
2. Submit blood donor's 2. Receive & check filled out None 10 minutes Clerk or Medical
form (Blood Bank Blood donor's form and instruct Technologist
Reception Area MAB to wait for name to be called for
Annex Building- interview
Mezzanine, 2nd Floor
Window 14)
3. Cooperate during 3. Log donor's data in the None 1 hour Medical Technologist
interview and blood logbook and call donor for
extraction for initial screening (pre-counselling)
screening and submit at 3.1 If qualified, extract blood
least 60 ml urine sample sample and collect urine
and fill up Custody 3.2 Instruct to wait for results of
Control Form (CCF) for initial screening 3.3 Perform
Drug Testing Blood Tests
(Blood Bank Donor
Screening Area - Complete Blood count (CBC)
MAB Annex Building- - Drug Testing on collected
Mezzanine 2nd Floor) Urine sample
- Blood Typing

3.4 Record result at donor's

logbook 5 minutes Medical Technologist

3.5 Counsel donor if not

qualified
3.6 if qualified, give instructions
on duration of blood testing
and preparation before the
Apheresis donation.
4. Wait for the result of 4. Perform Complete None 1 hour Medical Technologist
complete screening Transfusion Transmissible
(Blood Bank Donor Infection (TTI's) screening
Screening Area
MAB Annex Building- -HBsAg
Mezzanine 2nd Floor) -Anti-HCV
-Anti-HIV
-Malaria
-Syphilis
5. Submit for actual 5. Perform Apheresis None 2 ½ hours Medical Technologist or
Apheresis Procedure - procedure Nurse
Listen and cooperate in
Post-counselling 5.1 Conduct Post-Counselling

(Blood Bank Donor

Screening Area and
bleeding area MAB Annex
Building- Mezzanine 2nd
Floor)

Total Apheresis donation 4 hours & 50 minutes

Please see table of fees
End of Transaction
APPLICATION FOR MEDICAL STAFF MEMBERSHIP
Credentialing and Privileging for Medical Staff
Office or Division: Office of the Deputy Executive Director for Medical Services
Classification Highly Technical Transactions
Type of Transaction: G2C
Who may Avail: Medical Specialists / Consultants
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
See attached list of requirements OFFICE OF THE DEPUTY EXECUTIVE DIRECTOR FOR MEDICAL
SERVICES
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit application and 1. Receive and transmit None 1 day Deputy Executive Director
requirements application to the concerned for Medical
Department for evaluation of Services/Secretary
credentials and determination
of practice privileges

1.2 Evaluate
credentials, determine extent
of practice privileges 5 days Department Manager /
and transmit recommendations Division Chief
to Credentials Committee

1.3 Perform primary,

verification as necessary, to 4 weeks Credentials Committee
validate submitted
requirements.
Review recommendation by
concerned Department.
Recommend acceptance,
additional credentials review or
non-acceptance
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1.4 Review recommendations 1 day Medical EXECOM

of Credentials Committee for
final approval of PHC
Executive Director
Chairman of Medical
1.5 Evaluate application for 2 days Executive Committee /
membership to PHC Medical DEDMS
Staff

1.6 Notify regarding approval

and schedule a presentation to 1 day Secretary of DEDMS
Medical Staff meeting

2. Wait for notification of 2. Present Medical Staff during None

approval and presentation to Medical Staff meeting
Medical Staff meeting
Total None 40 days
End of Transaction
Arterial Blood Gas Test
A blood test to determine the oxygen level and acid-base status of the patient.

Office/Division: PULMONARY MEDICINE DIVISION/PULMONARY LABORATORY

Classification: SIMPLE

Type of Transaction: G2C

Who may avail: ALL

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Doctor's request Attending Physician – Clinic Room

For service patients

Service OPD card Social Service Division – Annex Bldg
If payment is through financial assistance/ HMO
1. Service Issue Slip (SIS)
2. Health Maintenance Organization Social Service Division – Annex Bldg.
(HMO) Letter Of Authorization (LOA) HMO Coordinator
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING PERSON
TIME RESPONSIBLE
1. Present requirements and fill 1. Receive requirements None 5 Minutes Clerk III
out patient data slip at 1.1 Check doctor's request Pulmonary Laboratory
Pulmonary Laboratory reception, 1.2 Issue patient data slip Reception area
Ground Floor, Hospital Bldg.

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING PERSON

TIME RESPONSIBLE
2. Receive charge slip and pay 2. Issue charge slip ABG Test – 35 Minutes Clerk III
applicable fees at designated 2.1 Instruct client to pay applicable P 715.00 Pulmonary Laboratory
Cashier area. fees and to return to Pulmonary ABG syringe – Reception area
Hospital Lobby, near stairway, Laboratory reception after payment P 103.50
Monday to Fridays Adhesive Bandage –
8 am - 9 pm P 31.50
Basement Cashier – Monday
to Sunday
8 am - 7:30 pm
Secure official receipt
3. Present official receipt at 3. Receive official receipt None 30 Minutes Clerk III
Pulmonary Laboratory reception 3.1 Instruct patient to wait for Pulmonary Laboratory
name to be called Reception area
3.2 Call Pedia Pulmo Fellow or
Pulmo on duty for new born to 10
year old patients.
4. Cooperate with blood 4. Perform blood extraction None 30 minutes Pedia Pulmonary Fellow
extraction at the Pulmonary *For new born to 10 years old Pulmonary Laboratory
Laboratory extraction area. Extraction area

*For 11 years old and above Respiratory Therapist

Pulmonary Laboratory
Extraction area

4.1 Analyze the blood Respiratory Therapist

Blood Gas Machine area

4.2 Encode the result Clerk III

Pulmonary Laboratory
Reception area

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING PERSON

TIME RESPONSIBLE
Blood Bank Procedures
Procedures that involve testing for Blood Typing and for serological tests (Syphilis and Hepatitis Test).

Office/Division: Blood Bank

Classification: Simple
Type of G2C – Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor's request (1 original copy) -Doctor's clinic
2. OPD Card (1 original copy) -for service patients -Social Service

If payment is through financial assistance/Insurance

1. Health Maintenance Organization (HMO) Letter of - HMO Coordinator
Authorization (LOA)
-Social Service
2. Service Issue Slip (SIS)

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present doctor's order 1. Check Doctor's request None 5 minutes Clerk or Medical
and issue applicable form Technologist
Blood Bank reception area,
window 14, MAB Annex
mezzanine
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

2. Fill out applicable form 2. Process registration and None 5 minutes Clerk
(for first time patients) issue request slip
2.1 For Cash Transaction –
Enter patient's information
and blood request in the
Blood Bank reception area, MedTrak and generate
window 14, MAB Annex charge slip (request slip)
mezzanine and instruct to proceed to
the cashier
2.2 For LOA/HMO – enter
patient's information and
execute request.
3. Pay applicable fees 3. Receive payment and None 30 minutes Cashier
issue official receipt.
Cashier's Office:
MAB Annex Building –
Mezzanine, 2nd Floor
Laboratory Medicine
Division Window 10
(6:00am – 11:30am);
Ground floor
Window 8 & 9
( 6:00am – 7:00pm);
Hospital building lobby
( 24/7) ; MAB Basement
( 8:00am – 8:00pm)
Please get official receipt
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

4. Present copy of Official 4. Record official receipt None 2 minutes Clerk or Medical
Receipt number. Technologist

4.1 Instruct patient to

proceed for blood
Blood Bank reception area, extraction
window 14, MAB Annex
mezzanine
5. Proceed for blood 5. Check request, official None 10 minutes Medical Technologist
extraction receipt and extract blood
sample and carry out
procedure -Instruct to come
Blood Bank screening area back for the result
MAB Annex mezzanine

6. Claim result (Blood 6. Issue result and ask None 5 minutes Clerk/Medical
Bank reception area patient to sign in the Technologist
window 14, MAB Annex logbook
mezzanine)
Note:

Running Schedule:

Anti HBs & Anti Hbc

Consult your doctor for
Total :
interpretation of result Mondays/
Wednesdays/Fridays
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

Total Blood Bank Blood typing: 1 hour

Procedures

Please see table of Syphilis and Hepatitis

fees Test: 1 day

End of Transaction
Blood and Blood Components Procurement
This service refers to the purchase of blood and blood components by individuals, other institutions and agencies.

Office/Division: Blood Bank

Classification: Simple
Type of Transaction: G2C, G2G, G2B
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor's request/ Hospital Blood request (1 - Doctor's Clinic/ Hospital
original copy)
2. Agency referral (approved Memorandum of
Agreement) (1 original copy) - If coming from - Partner Agencies
Partner Agency with signature of the coordinator.

3. Cooler with ice pack - From requesting Hospital or Personal

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present requirements 1. Receive requirements None 10 minutes Clerk or Medical
and check patient’s Technologist
If with Partner Agency
referral, proceed to Step information if completely
no. 4 to Step no. 5 filled up

1.1 Process registration

and issue charge slip
(request slip)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
 (Blood Bank Reception 1.2 Instruct client to pay None Clerk or Medical
Area, MAB Annex at the cashier and Technologist
Building- Mezzanine,
come back with
2nd Floor Window 14)
Official receipt
2. Pay applicable fees 2. Receive payment and Maximum allowable 30 minutes Cashier
issue Official Receipt processing fee for
(OR) blood & blood
components
Cashier's Office (MAB Annex
Building – Mezzanine, 2nd 1 unit Whole blood-
Floor Laboratory Medicine 1,800.00
1 unit Packed Red
Division Window 10
Blood Cell- 1,500.00
(6:00am – 11:30am); 1 unit Platelet
Ground floor Concentrate- 1,000.00
Window 8 & 9 1 unit Fresh Frozen
(6:00am – 7:00pm); Plasma – 1,000.00
Hospital building lobby ( 24/7) ; 1 unit Cryop-
MAB Basement (8:00am – recipitate- 1,000.00
8:00pm)
*with additional
charges for each unit*
Drug Assay – 250.00
Make sure to get official Storage & Handling
receipt Fees- 350.00
Antibody Screening
Test (per Component)-
150.00

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Present Official receipt 3. Record Official receipt None 5 minutes Clerk
to Blood Bank Reception number
Area

(Blood Bank Reception

Area, MAB Annex
Building- Mezzanine, 2nd
Floor Window 14)
4. Wait for blood and blood 4. Prepare and check None 20 minutes Medical Technologist
components to be released requested Blood/Blood
components for the
(Blood Bank Reception following:
Area, MAB Annex
a. Forward Blood Typing
Building- Mezzanine, 2nd for Packed Red Blood
Floor Window 14) Cell and Whole blood
b. Reverse Blood
Typing for Platelet
concentrate/Fresh
Frozen Plasma &
5. Check and receive blood 5. Check the issuance form None 15 minutes per unit of Medical Technologist
and blood components and received by the client blood.
sign blood issuance form
and logbook
Total Please see table of 1 hour and 20 minutes
fees above
End of Transaction
 PHILIPPINE HEART CENTER
BLOOD BANK SECTION

RATES – AUGUST 1, 2018

OPD,
Emergency Semi-Private Rooms Private Rooms/
Private Rooms
Room (ER), Including Semi-Private in
Rooms in
PROCEDURE Service and SICU/MICU/CCU/ SICU/MICU/ SUITE ROOMS
PICU/NICU/Isolation
Pay Wards Rooms CCU/PICU
One unit of ABO/AB Whole Blood
1 (500cc) 1,800 1,800 1,800 1,800
2 One unit of ABO/AB Packed RBC 1,500 1,500 1,500 1,500
3 One unit of Platelet Concentrate 1,000 1,000 1,000 1,000
4 One unit of Fresh Frozen Plasma 1,000 1,000 1,000 1,000
5 One unit of Fresh Plasma 1,000 1,000 1,000 1,000
6 One unit of Platelet Rich Plasma 1,000 1,000 1,000 1,000
7 One unit of Cryoprecipitate 1,000 1,000 1,000 1,000
8 One unit of Cryosupernate 1,000 1,000 1,000 1,000
9 One unit of Washed RBC 4,700 5,400 6,100 6,800
10 Storage and Handling 350 405 455 510
11 ABO/Rh Blood Typing 350 405 455 510
12 Rh Blood Typing 200 230 260 290
13 Three Phases of Crossmatching 550 635 715 800
14 Bleeding of one (1) donor 500 575 650 725
15 Initial Screening of one (1) donor 1,200 1,200 1,200 1,200
16 Complete Screening of one (1) donor 1,300 1,300 1,300 1,300
Screening and Bleeding of one (1)
15 donor 1,800 1,800 1,800 1,800
16 Screening and Bleeding (Whole Blood) 1,800 1,800 1,800 1,800
17 Direct Coomb's Test 300 345 390 435
18 Cold Agglutinins 650 750 845 945
19 Quantitative Cold Agglutinins 1,300 1,500 1,700 1,900
20 Antibody Screening Test (Donor) 550 635 715 800

21 Antibody Screening Test (Patient) 750 865 975 1,100

Antibody Screening Test (Per
22 Component) 150 175 195 220
23 Hep B Surface Antigen (HBsAg) 850 1,000 1,100 1,250
24 Hep B Surface Antibody (Anti-HBs) 850 1,000 1,100 1,250
25 Hep B Core Antibody (Anti-Hbc) 850 1,000 1,100 1,250
26 Hep C Virus Antibody (Anti-HCV) 950 1,100 1,235 1,400
27 Anti HBC IgG 850 1,000 1,100 1,250
28 Syphilis 550 635 715 800
29 HIV Test 850 1,000 1,100 1,250
30 Malaria Screening Test 540 620 700 785
31 Drug Assay 250 290 325 365
Pheresis (Haemonetics) procedure* (8
32 units) 16,350 18,800 21,250 23,700
MISCELLANEOUS ITEMS
33 Additional Copy of Laboratory Result 15 15 15 15
34 Handling fees for send-out specimens 400 460 520 580
Blood Culture and Sensitivity Test
Laboratory procedure which aims to cultivate, evaluate and identify clinically significant microorganisms that cause infection in blood. A
sensitivity test gives information on what antibiotic will work best to treat the infection.

Office/Division: Laboratory Medicine Division

Classification: Complex
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s request - Doctor’s Clinic
2. OPD Card (for service patients) - Outpatient Division
3. Health Maintenance Organization (HMO) card - HMO Provider
and Letter of Authorization (LOA) (if applicable)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present doctor’s request 1. Receive doctor’s None 20 minutes Receptionist-on-duty
and wait for name to be request
called.
1.1. Instruct patient to wait
nd
(Window 10, 2 floor for name to be called
Medical Arts Building
Annex) 1.2 Register patient’s data

1.3 Issue charge slip Cashier-on-duty

and/or forward to cashier
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Once name is called, get Call patient’s name, Please see 20 minutes Cashier-on-duty
charge slip and pay receive payment and Laboratory Tests
applicable fees issue official receipt Price List

(6am to 11:30am- Payment

Window, 2nd floor Medical
Arts Building Annex)

(11:30 onwards-Cashier’s
Office Basement Hospital
Building and OPD Cashier)

Make sure to keep charge

slip and get official receipt

2.1 For HMO card holders,

get charge slip from
Window 10

3. Proceed to Window 11, 3. Enter and stamp Official Receipt and 5 minutes Receptionist-on-duty
present charge slip and requested laboratory tests Charge slip
official receipt in the Laboratory
Information System

3.1 Return charge slip and

(Mezzanine MAB Annex) OR to patient and issue
number for Blood
Extraction
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Once number is called, 4. Call patient’s number None 15 minutes Medical Technologist-on-
proceed to blood extraction for blood extraction duty
room

(Room 12, Mezzanine MAB

Annex) 4.1 Conduct Laboratory Medical Technologist-on
Test procedure duty

5. Claim official result 5. Release official result None 7 days Staff-on-duty

Consult your doctor for interpretation of results
Total None 7 days and 1 hour
End of Transaction
 Blood Donor Screening and Donation
This refers to the process of screening individuals for blood donation. Only persons in normal health with a good medical history and
absence of high risk behavior associated with transfusion-transmissible infections shall be accepted as donors of blood or a component of
blood.

Office/Division: Blood Bank

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Inquire about blood donation 1. Explain about Blood None 5 minutes Clerk or Medical
/secure and fill out Blood Donor's Donation using leaflets on Technologist
Form Donor's qualification
(Blood Bank Reception Area MAB 1.1 Issue blood donor form
Annex Building- Mezzanine, 2nd and assist blood donor in
Floor Window 14) filling out of form

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Submit blood donor's form 2. Receive & check filled out None 10 minutes Clerk or Medical
(Blood Bank Reception Area MAB Blood donor's form and Technologist
Annex Building- Mezzanine, 2nd instruct to wait for name to be
Floor Window 14) called for interview
3. Undergo interview and blood 3. Log donor's data in the None 1 hour Medical Technologist
extraction for initial screening and logbook and call donor for
submit at least 60 ml urine sample screening (pre-counselling)
and fill up Custody Control Form 3.1 If qualified, extract blood
(CCF) for Drug Testing sample and collect urine
(Blood Bank Donor Screening 3.2 Instruct to wait for results
Area MAB Annex of initial screening
Building- Mezzanine 2nd Floor) 3.3 Perform Blood Tests on
extracted blood sample
- Complete Blood count (CBC)
- Drug Testing on collected
urine sample
- Blood Typing
3.4 Record result at donor's
logbook
3.5 Counsel donor if not
qualified
3.6 if qualified proceed with
actual bleeding procedure.

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Submit for Blood Donation - 4. Prepare blood bags and do None 45 minutes Medical Technologist
Listen and cooperate in Post- aseptic collection of donors
counselling blood (450ml)
(Blood Bank Donor Bleeding area ,
MAB Annex Building- Mezzanine) 4.1 Conduct Post -
Counselling

End of Actual Blood Donation

** For donors who do not qualify, charges will be according to the tests conducted

End of Complete Screening

Total Blood Donor screening and 2 hours
donation Please see table of fees at
Blood Bank reception area
End of Transaction

PHILIPPINE HEART CENTER

 BLOOD BANK SECTION

RATES – AUGUST 1, 2018

OPD, Emergency Semi-Private Rooms Private Rooms/

Room (ER), Including Semi-Private Private Rooms in
Rooms in
PROCEDURE Service and SICU/MICU/CCU/ SICU/MICU/ SUITE ROOMS
PICU/NICU/Isolation
Pay Wards Rooms CCU/PICU
1 One unit of ABO/AB Whole Blood (500cc) 1,800 1,800 1,800 1,800
2 One unit of ABO/AB Packed RBC 1,500 1,500 1,500 1,500
3 One unit of Platelet Concentrate 1,000 1,000 1,000 1,000
4 One unit of Fresh Frozen Plasma 1,000 1,000 1,000 1,000
5 One unit of Fresh Plasma 1,000 1,000 1,000 1,000
6 One unit of Platelet Rich Plasma 1,000 1,000 1,000 1,000
7 One unit of Cryoprecipitate 1,000 1,000 1,000 1,000
8 One unit of Cryosupernate 1,000 1,000 1,000 1,000
9 One unit of Washed RBC 4,700 5,400 6,100 6,800
10 Storage and Handling 350 405 455 510
11 ABO/Rh Blood Typing 350 405 455 510
12 Rh Blood Typing 200 230 260 290
13 Three Phases of Crossmatching 550 635 715 800
14 Bleeding of one (1) donor 500 575 650 725
15 Initial Screening of one (1) donor 1,200 1,200 1,200 1,200
16 Complete Screening of one (1) donor 1,300 1,300 1,300 1,300
15 Screening and Bleeding of one (1) donor 1,800 1,800 1,800 1,800
16 Screening and Bleeding (Whole Blood) 1,800 1,800 1,800 1,800
17 Direct Coomb's Test 300 345 390 435
18 Cold Agglutinins 650 750 845 945
19 Quantitative Cold Agglutinins 1,300 1,500 1,700 1,900
20 Antibody Screening Test (Donor) 550 635 715 800
21 Antibody Screening Test (Patient) 750 865 975 1,100
22 Antibody Screening Test (Per Component) 150 175 195 220
23 Hep B Surface Antigen (HBsAg) 850 1,000 1,100 1,250
24 Hep B Surface Antibody (Anti-HBs) 850 1,000 1,100 1,250
25 Hep B Core Antibody (Anti-Hbc) 850 1,000 1,100 1,250
26 Hep C Virus Antibody (Anti-HCV) 950 1,100 1,235 1,400
27 Anti HBC IgG 850 1,000 1,100 1,250
28 Syphilis 550 635 715 800
29 HIV Test 850 1,000 1,100 1,250
30 Malaria Screening Test 540 620 700 785
31 Drug Assay 250 290 325 365
Pheresis (Haemonetics) procedure* (8
32 units) 16,350 18,800 21,250 23,700
MISCELLANEOUS ITEMS
33 Additional Copy of Laboratory Result 15 15 15 15
34 Handling fees for send-out specimens 400 460 520 580
 PHILIPPINE HEART CENTER
BLOOD BANK SECTION

RATES – AUGUST 1, 2018

OPD,
Emergency Semi-Private Rooms Private Rooms/
Room (ER), Including Semi-Private Private Rooms in
Rooms in
PROCEDURE Service and SICU/MICU/CCU/ SICU/MICU/ SUITE ROOMS
PICU/NICU/Isolation
Pay Wards Rooms CCU/PICU
1 One unit of ABO/AB Whole Blood (500cc) 1,800 1,800 1,800 1,800
2 One unit of ABO/AB Packed RBC 1,500 1,500 1,500 1,500
3 One unit of Platelet Concentrate 1,000 1,000 1,000 1,000
4 One unit of Fresh Frozen Plasma 1,000 1,000 1,000 1,000
5 One unit of Fresh Plasma 1,000 1,000 1,000 1,000
6 One unit of Platelet Rich Plasma 1,000 1,000 1,000 1,000
7 One unit of Cryoprecipitate 1,000 1,000 1,000 1,000
8 One unit of Cryosupernate 1,000 1,000 1,000 1,000
9 One unit of Washed RBC 4,700 5,400 6,100 6,800
10 Storage and Handling 350 405 455 510
11 ABO/Rh Blood Typing 350 405 455 510
12 Rh Blood Typing 200 230 260 290
13 Three Phases of Crossmatching 550 635 715 800
14 Bleeding of one (1) donor 500 575 650 725
15 Initial Screening of one (1) donor 1,200 1,200 1,200 1,200
16 Complete Screening of one (1) donor 1,300 1,300 1,300 1,300
15 Screening and Bleeding of one (1) donor 1,800 1,800 1,800 1,800
16 Screening and Bleeding (Whole Blood) 1,800 1,800 1,800 1,800
17 Direct Coomb's Test 300 345 390 435
18 Cold Agglutinins 650 750 845 945
19 Quantitative Cold Agglutinins 1,300 1,500 1,700 1,900
20 Antibody Screening Test (Donor) 550 635 715 800

21 Antibody Screening Test (Patient) 750 865 975 1,100

Antibody Screening Test (Per
22 Component) 150 175 195 220
23 Hep B Surface Antigen (HBsAg) 850 1,000 1,100 1,250
24 Hep B Surface Antibody (Anti-HBs) 850 1,000 1,100 1,250
25 Hep B Core Antibody (Anti-Hbc) 850 1,000 1,100 1,250
26 Hep C Virus Antibody (Anti-HCV) 950 1,100 1,235 1,400
27 Anti HBC IgG 850 1,000 1,100 1,250
28 Syphilis 550 635 715 800
29 HIV Test 850 1,000 1,100 1,250
30 Malaria Screening Test 540 620 700 785
31 Drug Assay 250 290 325 365
Pheresis (Haemonetics) procedure* (8
32 units) 16,350 18,800 21,250 23,700
MISCELLANEOUS ITEMS
33 Additional Copy of Laboratory Result 15 15 15 15
34 Handling fees for send-out specimens 400 460 520 580
Bone Densitometry Procedures
Measurement of a patient’s bone density using Dual X-ray Absorptiometry

Office or Division: Nuclear Medicine Division

Classification: Simple
Type of Transaction: G2C

Who may avail: All

CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s Request Clinic of the referring physician.

2. OPD Card(for PHC service patient) Philippine Heart Center, Out Patient Division.

3. Ancillary and/or laboratory results and Laboratory and/or referring physician

medication prescriptions

4. Official Receipt of payment - Will be provided upon payment at the Treasury office.
(Official receipt from the Treasury office)

5. Other documents which maybe

Accepted as proof of payment. -DOH, PCSO
(HMO, LOA, Service Issue Slip -HMO Coordinator
(Guarantee Letters etc) – (pending approval of the PHC administration)
as long as it is approved by
Philippine Heart Center.)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present bone 1. Receive and verify None 5minutes Administrative Assistant or
densitometry request at the bone densitometry Nuclear Medical
front desk. request, inform the price Technologists or
of the procedure and Nuclear Radiologic
1.1 Fill-out applicable form. issue applicable form to Technologist
fill-out and sign.
(Nuclear Medicine Division,
Pagbubungkos Plaza)

2. Proceed to the Interview 2. Evaluate the patient None 10 minutes Nuclear Medicine
area. Resident/Fellow

3. Proceed for the schedule 3 Schedule the patient on None 5 minutes Administrative Assistant or
at the Nuclear front desk. the same day if the Nuclear Medical
patient has no Calcium Technologists or
intake within twenty-four Nuclear Radiologic
(24) hours. Technologist

Note: The patient is to

be scheduled on the
next earliest available
day if with Calcium
intake within twenty-
four (24) hours.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

4. Proceed for the 4. Check and verify None 1 hour and Administrative
procedure at the DEXA requested procedure. Assistant or Nuclear Medical
room. 3 minutes Technologists or
4.1 Image the patient. Nuclear Radiologic
Technologist
4.2 Process the images.

4.3 Issue charge slip and

instruct patient to come Nuclear Medical Consultant &
back to Nuclear front desk Fellow/resident
after payment.

5. Pay applicable fees at the 5. Receive payment and See attached table of 30 minutes Cashier I
Treasury office. Make sure issue official receipt. fees at Nuclear
to get official receipt. Medicine Imaging
Procedure
(Treasury office at
basement of the Medical
Arts Building and ground
floor of the Hospital building)

6. Present the official receipt 6. Record the official None 2 working days and 2 Administrative Assistant or
at the Nuclear Medicine receipt number. minutes Nuclear Medical
front desk. Technologists or
6.1 Interpret and review Nuclear Radiologic
Technologist
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

the process image.

6.2 Instruct patient to

come back after 2 working
days.

7. Claim result at the 7. Release the official None 5 minutes Administrative Assistant or
Nuclear front desk on the result. Nuclear Medical
schedule date and sign on Technologists or
Nuclear Radiologic
the logbook.
Technology
(Nuclear Medicine Division,
Pagbubungkos Plaza)

Consult your doctor for interpretation of results

TOTAL: See table of fees 2 working days and 2
hours

End of Transaction
Bronchoscopy Procedure
Endoscopic technique for visualizing the airways for diagnostic and therapeutic purposes.

Office/Division: PULMONARY MEDICINE DIVISION/BRONCHOSCOPY UNIT

Classification: SIMPLE
Type of Transaction G2C
Who may avail: ALL
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 Doctor's request (1 original) Attending Physician – Clinic Room
 X-ray / CT Scan result Hospital / Diagnostic Clinic
 Letter of Authorization (1 original) HMO Coordinator
 Claim Signature Form, Philhealth ID, Senior ID, Philhealth Kiosk
Certificate of Contribution, Membership Data
Record (MDR)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present requirements 1. Receive and issue None 2 Minutes Pulmonary Fellow
consent Pulmonary Laboratory
Reception Area
2. Accomplish consent and Fall 2. Assist and Orient None 5 Minutes Pulmonary Consultant /
Risk Agreement client in filling out form Respiratory Therapist
Bronchoscopy Room 111
3. Undergo and cooperate in the 3. Perform procedure None 40 Minutes Pulmonary Consultant /
procedure and payment slip Respiratory Therapist
Bronchoscopy Room 111
4. Pay applicable fees 4. Receive official Bronchoscopy 30 Minutes Respiratory Therapist
receipt Procedure – Pulmonary Laboratory
Cashier Office, Basement P10,240.00 Reception Area
Medical Arts Building Reader's Fee -
P8,000.00
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING PERSON RESPONSIBLE
TIME
5. Submit specimen 5. Accompany relative None 30 Minutes Respiratory Therapist
or patient to Laboratory Medicine Reception
Laboratory Medicine Area, Annex Bldg, Mezzanine
for specimen delivery
Total P18,240.00 2 hours
End of Transaction
Cardiac Health Education, Enhancement & Restoration Service (C.H.E.E.R.S.) Clearance
A pioneer in preoperative psychological management that particularly seeks to help surgical candidates prepare psychologically for operation.
It also intends to address any existing psychiatric and psychological problems the patient may have.

Office/Division: Psychiatry And Behavior Medicine Section

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: OPD Service Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
OPD Card Social Service Division
Referral Slip Out Patient Division
Latest 2D Echo Result Medical Records
One (1) 1x1 I.D. picture and ballpen To be brought by the patient
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present requirements 1. Receive requirements, None 5 minutes Clerk III
and get a schedule for 1.1. Instruct patient on
the Group Introductory preparation for the
Session/ C.H.E.E.R.S. C.H.E.E.R.S. seminar
seminar 1.2. Schedule patient
2. Come on the 2. C.H.E.E.R.S. seminar None 4 hours Medical Specialist III
scheduled date, fill-out activities:
forms/ questionnaire - Administration of
and participate in the psychological
C.H.E.E.R.S. seminar assessment tool
- Orientation to the
program
- Psychological Education

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Set an appointment for 3. The admin. staff None 30 minutes Clerk III
the individual interview schedules the patient for
with the psychiatrist the one-on-one session
with the psychiatrist
4. Come on the 4. The Psychiatrist None 2 hours Psychiatrist
scheduled date and time performs mental status
for the Individual examination and
Assessment and evaluation. Psychiatric
Counseling management will also be
done, if needed
5. Proceed to Cashier to 5. Receive payment and P200 (Cat. B) 30 minutes Cashier I or Cashier II of the
pay for the C.H.E.E.R.S. issue Official Receipt P150 Cashier's Office
Evaluation Fee (O.R.) (Cat. C1)
P100
(Cat. C2)
P50
(Cat. C3)
P30
(Cat.D)

6. Present Official 6. Record patient data None 5 minutes Clerk III

Receipt and claim the and O.R. number, then
C.H.E.E.R.S. Clearance give the C.H.E.E.R.S.
Clearance to the patient
7. Answer the Feedback 7. Feedback Form is None 10 minutes Clerk III
Form given to the patient as
satisfaction evaluation
tool
Total See Step 5 for list of fees 7 hours and 20 mins
End of Transaction

PHILIPPINE HEART CENTER

PSYCHIATRY AND BEHAVIOR MEDICINE SECTION

RATES – AUGUST 1, 2018

CHEERS EVALUATION FEES

Category A Pay P 200.00 (Full)

B Pay 200.00 (Full)
C1 - 25% QFS (Discount)
C2 - 50% QFS (Discount)
C3 - 75% QFS (Discount)
D - 85% QFS (Discount)
Cardiopulmonary Exercise Test
A non-invasive procedure to assess the functional performance of the heart and lungs at rest during exercise that involves an
expired gas analysis.

Office/Division: Pulmonary Medicine Division/Pulmonary Rehabilitation Unit

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All ambulatory patients who can follow instructions
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request of Procedure (1 original copy) Doctor's clinic
2. Laboratory and diagnostic test ( Spirometry, Chest X-
ray, ABG, CBC, CT scan, 2Decho ( 1 photocopy each)

If payment is through financial assistance;

1. Service Issue Slip –Social

Service Division
2. Guarantee Letter/Letter of Authorization –HMOCoordinator
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Present 1. Receive None 5 minutes RT Coordinator
requirements and requirements CRF
get a schedule of Pulmonary Rehabilitation Unit
procedure at the 1.1. Interview, instruct Reception area
pulmonary and schedule the
rehabilitation patient
reception area
MAB 8th floor 1.2 Issue Information
Sheet and Consent
Form

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE

 PAID TIME
2. Fill-out information 2. Assist client in None 10 minutes RT Coordinator
sheet filling out forms CRF
and consent form 2.1 Get vital signs Pulmonary Rehabilitation Unit
Reception area
3. Receive charge slip and 3. Issue charge slip Procedure 30 minutes RT Coordinator
pay applicable fees at 3.1. Receive P 6,600.00 Pulmonary Rehabilitation Unit
Cashier's office ground payment and
floor lobby or Basement issue Official Professional Cashier 1 or 2
Cashier's office GF lobby
receipt (OR) fee
or Basement
Make sure to get OR P 800.00

4. Present official receipt 4. Record patient data None 5 minutes RT Coordinator

and OR receipt CRF
Pulmonary Rehabilitation Unit
MAB 8th Floor, Pulmonary Reception area
Rehabilitation Unit
Reception Area
5. Cooperate during 5. Assist patient in the None 30 minutes RT Coordinator
performance of performance of the CRF
procedure procedure and notify Pulmonary Rehabilitation Unit
date of result
6. Claim result on the 6. Release of result None 3 days CRF
scheduled date
Consult your doctor for interpretation of results
P 7,400.00 3 days , 1 hour
Total
& 20 minutes
End of Transaction
Claiming of Dead Body
Procedure to be followed in claiming the body of deceased patient.

Office/Division: Laboratory Medicine Division

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Authorization for release of body form - Cashier’s Office
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Proceed to the Morgue 1. Inform laboratory None 10 minutes Security-guard-on-duty
and tell the security guard personnel
about the claim
(Morgue, Basement Hospital
Building)
2. Present completely filled- 2. Receive and check None 2 minutes Staff-on-duty
out authorization form for requirement and availability
release of body of funeral service

3. Identify body of deceased 3. Assist in the identification None 5 minutes Staff-on-duty

patient of the body of deceased
patient
4. Claim body of the 4. Sign the authorization None 5 minutes Staff-on-duty
deceased patient form and write time and date
in the logbook before
releasing the body

4.1 Require funeral service

agent to sign the
authorization and leave a
contact number
Total None 22 minutes
End of Transaction
Consultation-Liaison/In-Patient Referral
The Consultation-Liaison service is intended to manage psychiatric/psychological problems of patients confined in the hospital.

Office/Division: Psychiatry And Behavior Medicine Section

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: OPD Service Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. If the patient 1. Referral to the None 5 minutes Ward Nurse or Cardio Fellow
manifests psychiatric Psychiatry and Behavior
sign and symptoms Medicine (written in the
chart)
2. Patient will prepare 2. Gather patient info None 10 minutes Clerk III
for psychiatric identify reason for
treatment referral
3. Cooperate with the 3. Evaluate and give None 2 hours Medical Specialist III
procedure psychiatric management

Total None 2 hours and 15 mins

End of Transaction
CT Guided Biopsy Processing
Invasive Diagnostic Procedure that uses CT- Scan modality to assist in localization of needle in aspiration biopsy procedure.

Office/Division: CT-Scan Section

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 Request of Procedure ( 1 original copy) - Doctor’s Clinic
 Bleeding Parameters (PTPA Result)
 Previous CT Scan CD/plates and result - Laboratory
If payment is through financial assistance/Insurance
1.Service Issue Slip
2.Health Maintenance Organization (HMO) - PHC Social Service
Letter of Authorization (LOA) - HMO Coordinator
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present 1. Assess and instruct None 15 minutes Interventional Radiology
requirements patient on schedule and Fellow
and get preparation of procedure
schedule at CT-Scan Reception Area
CT-Scan 1.2. Issue applicable forms
Reception Area
2. Fill out and 2. Assist client in filling out of None 5 minutes Clerk or Radiologic
sign applicable forms Technologist
document at
the CT-Scan CT-Scan Reception Area
reception area
3. Pay applicable 3. Receive payment and See table of fees 30 minutes Cashier 1 or Cashier 2
fees at the Cashier's issue Official Receipt (OR)
Office Ground Floor Cashier's Office
lobby or Basement Ground Floor lobby or
Basement
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
 PHILIPPINE HEART CENTER
RADIOLOGICAL SCIENCES DIVISION

RATES – August 1, 2018

OPD, Emergency Room Semi-Private Rooms Private Rooms/Private

(ER), Service and Pay Including Semi-Private Rooms in SICU/MICU/
PROCEDURE Wards Rooms, SICU/MICU/CCU/ CCU/PICU SUITE ROOMS
PICU/NICU, Isolation Rooms
Hospita Hospita Hospita TOT
CT SCAN Hospital PF TOTAL l PF TOTAL l PF TOTAL l PF AL
1,20 4,85 1,40 6,25 5,45 1,55 6,10 1,75
1. Cranial Plain 4,200 0 5,400 0 0 0 0 0 7,000 0 0 7,850
Cranial W/ 1,20 5,10 1,40 6,50 5,80 1,55 6,45 1,75
2. Contrast 4,450 0 5,650 0 0 0 0 0 7,350 0 0 8,200
Head Perfusion 2,40 8,65 2,75 11,4 9,75 3,10 12,85 10,9 3,50 14,40
3. w/ Contrast 7,500 0 9,900 0 0 00 0 0 0 00 0 0
Temporal / IAC 1,20 6,90 1,40 8,30 7,80 1,55 8,70 1,75 10,45
4. Plain 6,000 0 7,200 0 0 0 0 0 9,350 0 0 0
Temporal / IAC 1,20 7,50 1,40 8,90 8,45 1,55 10,00 9,45 1,75 11,20
5. w/ Contrast 6,500 0 7,700 0 0 0 0 0 0 0 0 0
1,20 6,90 1,40 8,30 7,80 1,55 8,70 1,75 10,45
6. Orbit Plain 6,000 0 7,200 0 0 0 0 0 9,350 0 0 0
1,20 7,50 1,40 8,90 8,45 1,55 10,00 9,45 1,75 11,20
7. Orbit w/ Contrast 6,500 0 7,700 0 0 0 0 0 0 0 0 0
PNS / Facial 1,20 5,60 1,40 7,00 6,30 1,55 7,05 1,75
8. Plain 4,850 0 6,050 0 0 0 0 0 7,850 0 0 8,800
PNS / Facial w/ 1,20 7,00 1,40 8,40 7,95 1,55 8,85 1,75 10,60
9. Contrast 6,100 0 7,300 0 0 0 0 0 9,500 0 0 0
CT/MRI Procedure
Type of imaging test that help the doctor make an accurate diagnosis and choose the ideal treatment plan. Each imaging test uses
different technology to create images that help your doctor identify certain medical complications.

Office/Division: CT/MRI Section

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request of procedure ( 1 original copy) - Doctor’s Clinic
2. Creatinine Result (if with contrast procedure)
3. Previous CT/MRI CD/Plates with result (if applicable) - Laboratory
for comparison
4. Official Receipt (for claiming of result)

If payment is through financial assistance/Insurance

1.Service Issue Slip - PHC Social Service
2.PCSO Guarantee Letter - PHC Credit and Collection/Social Service
3.Health Maintenance Organization (HMO) - HMO Coordinator
Letter of Authorization (LOA)

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present 1. Receive None 10 minutes Clerk or Radiologic
requirement Requirements Technologist
s and get a
schedule of 1.1.Instruct patient on CT-MRI Reception Area
procedure preparation of procedure
at the CT-
MRI 1.2.Schedule patient
reception
area
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Fill out and 2. Issue out applicable None 5 minutes Clerk or Radiologic
 sign forms Technologist
applicable
document 2.1. Assist client in filling out CT-MRI Reception Area
at the CT- of forms
MRI
reception 2.2.Issue queuing number
area
3. Proceed 3. Receive payment and See table of fees 30 minutes Cashier 1 or Cashier 2
and Pay issue Official Receipt (OR)
applicable Cashier's Office
fees at the Ground Floor lobby or
Cashier's Office Basement
Ground Floor
lobby or Basement

4. Present 4. Record patient data and None 5 minutes Clerk or Radiologic

Official OR Number Technologist
Receipt at
the CT-MRI CT-MRI Reception Area
Reception
Area
5. Wait for 5. Get patient's history None CT Scan-1hour Radiologic Technologist,
your MRI-2hours Nurse, Doctor
number to 5.1.Insert IV line (for
be called contrast procedure) CT-MRI Examination Room
and
Proceed for 5.2.Perform the requested
Procedure procedure/s
at the CT
Scan/MRI
examination
room
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
6. Proceed to 6. Check Image quality None 1 hour Nurse,Radiologic
patient's Technologist,
Waiting 6.1 Monitor patient for Doctor
Area for possible contrast reactions
further (for contrast procedure) Patient's Waiting Area
Instructions
6.2.Remove IV line (for
contrast procedure)

6.3.Doctor will read/interpret

the image

6.4.Instruct patient to come

back after 1 day for the
result
7. Claim result 7.Release result None 1 day Clerk or Radiologic
at the CT- Technologist
MRI 7.1.Request patient/relative
Reception to sign in the receiving CT-MRI Reception Area
Area and logbook as proof or receipt
present it to
the
Attending/
Referring
Physician
Consult your doctor for interpretation of results
Total See table of fees 1 Day
End of Transaction
 PHILIPPINE HEART CENTER
RADIOLOGICAL SCIENCES DIVISION

RATES – August 1, 2018

OPD, Emergency Room Semi-Private Rooms Private Rooms/Private

(ER), Service and Pay Including Semi-Private Rooms in SICU/MICU/
PROCEDURE Wards Rooms, SICU/MICU/CCU/ CCU/PICU SUITE ROOMS
PICU/NICU, Isolation
Rooms
Hospita Hospita Hospita Hospita
MRI l PF TOTAL l PF TOTAL l PF TOTAL l PF TOTAL
MRI Head / Brain 1,20 1,4 9,75 1,5 11,0 10,50 1,7 12,2
1. Plain 7,260 0 8,460 8,350 00 0 9,450 50 00 0 50 50
MRI Head / Brain w/ 1,20 1,4 9,75 1,5 11,0 10,50 1,7 12,2
2. GD 7,260 0 8,460 8,350 00 0 9,450 50 00 0 50 50
MRI DWI (Stoke 1,20 1,4 6,25 1,5 7,00 1,7 7,85
3. Protocol Only) 4,200 0 5,400 4,850 00 0 5,450 50 0 6,100 50 0
1,20 1,4 6,25 1,5 7,00 1,7 7,85
4. Head MRA Only 4,200 0 5,400 4,850 00 0 5,450 50 0 6,100 50 0
MRI Head Brain 1,20 1,4 10,3 10,15 1,5 11,7 11,30 1,7 13,0
5. Seizure 7,800 0 9,000 8,950 00 50 0 50 00 0 50 50
1,20 1,4 10,3 10,15 1,5 11,7 11,30 1,7 13,0
6. MRI Orbit 7,800 0 9,000 8,950 00 50 0 50 00 0 50 50
1,20 10,70 10,95 1,4 12,3 12,35 1,5 13,9 13,80 1,7 15,5
7. MRI Orbit w/ GD 9,500 0 0 0 00 50 0 50 00 0 50 50
MRI Head /Brain 11,30 3,50 14,80 13,00 4,0 17,0 14,70 4,5 19,2 16,40 5,1 21,5
8. Spectroscopy 0 0 0 0 50 50 0 50 50 0 00 00
MRI Head /Brain 15,95 4,00 19,95 18,35 4,6 22,9 20,75 5,2 25,9 23,15 5,8 28,9
9. Spectroscopy w/GD 0 0 0 0 00 50 0 00 50 0 00 50
1 MRI MRA Head / 2,40 2,7 11,1 3,1 12,5 10,50 3,5 14,0
0. Brain Plain 7,260 0 9,660 8,350 50 00 9,450 00 50 0 00 00
1 MRI MRA Head / 2,40 11,70 70,70 2,7 73,4 12,10 3,1 15,2 13,50 3,5 17,0
1. Brain w/GD 9,300 0 0 0 50 50 0 00 00 0 00 00
1 MRI MRA MRV 3,60 13,10 10,95 4,1 15,1 12,35 4,7 17,0 13,80 5,2 19,0
2. Head/ Brain Plain 9,500 0 0 0 50 00 0 00 50 0 00 00
1 MRI MRA MRV 3,60 13,50 11,40 4,1 15,5 12,85 4,7 17,5 14,35 5,2 19,5
3. Head/ Brain w/GD 9,900 0 0 0 50 50 0 00 50 0 00 50
MRI MRA Head and
1 MRA Neck Vessel 3,60 13,10 10,95 4,1 15,1 12,35 4,7 17,0 13,80 5,2 19,0
4. Plain 9,500 0 0 0 50 00 0 00 50 0 00 00
MRI MRA Head and
1 MRA Neck Vessel 3,60 13,50 11,40 4,1 15,5 12,85 4,7 17,5 14,35 5,2 19,5
5. w/GD 9,900 0 0 0 50 50 0 00 50 0 00 50
1 MRA Neck Vessel 1,20 1,4 7,40 1,5 8,30 1,7 9,30
6. only Plain 5,200 0 6,400 6,000 00 0 6,750 50 0 7,550 50 0
1 MRA Neck Vessel 1,20 1,4 10,3 10,15 1,5 11,7 11,30 1,7 13,0
7. only w/GD 7,800 0 9,000 8,950 00 50 0 50 00 0 50 50
1 1,20 10,70 10,95 1,4 12,3 12,35 1,5 13,9 13,80 1,7 15,5
8. MRI Sella / Pituitary 9,500 0 0 0 00 50 0 50 00 0 50 50
1 MRI Sella / Pituitary 1,20 10,80 11,04 1,4 12,4 12,50 1,5 14,0 13,90 1,7 15,6
9. w/GD (Dynamic) 9,600 0 0 0 00 40 0 50 50 0 50 50
2 MRI IAC / Temporal 1,20 10,70 10,95 1,4 12,3 12,35 1,5 13,9 13,80 1,7 15,5
0. Plain 9,500 0 0 0 00 50 0 50 00 0 50 50
2 MRI IAC / Temporal 1,20 10,80 11,05 1,4 12,4 12,50 1,5 14,0 13,90 1,7 15,6
1. Plain w/GD 9,600 0 0 0 00 50 0 50 50 0 50 50
2 MRI Neck/ Naso / 1,20 10,70 10,95 1,4 12,3 12,35 1,5 13,9 13,80 1,7 15,5
2. Oro Plain 9,500 0 0 0 00 50 0 50 00 0 50 50
2 MRI Neck/ Naso / 1,20 10,80 11,05 1,4 12,4 12,50 1,5 14,0 13,90 1,7 15,6
3. Oro w/GD 9,600 0 0 0 00 50 0 50 50 0 50 50
2 1,20 10,70 10,95 1,4 12,3 12,35 1,5 13,9 13,80 1,7 15,5
4. MRI Chest Plain 9,500 0 0 0 00 50 0 50 00 0 50 50
2 1,20 10,80 11,05 1,4 12,4 12,50 1,5 14,0 13,90 1,7 15,6
5. MRI Chest w/GD 9,600 0 0 0 00 50 0 50 50 0 50 50
2 MRI Breast / 11,2 2,4 13,6 12,90 2,7 15,6 14,55 3,1 17,6 16,25 3,5 19,7
6. Mammogram Plain 00 00 00 0 50 50 0 00 50 0 00 50
 MRI Breast /
2 Mammogram w/GD 11,5 2,4 13,9 13,20 2,7 15,9 14,95 3,1 18,0 16,70 3,5 20,2
7. (Dynamic) 00 00 00 0 50 50 0 00 50 0 00 00
2 MRI Upper 9,50 1,2 10,7 10,95 1,4 12,3 12,35 1,5 13,9 13,80 1,7 15,5
8. Abdomen Plain 0 00 00 0 00 50 0 50 00 0 50 50
2 9,60 2,4 12,0 11,05 2,7 13,8 12,50 3,1 15,6 13,90 3,5 17,4
9. MRCP Plain 0 00 00 0 50 00 0 00 00 0 00 00
3 MRI Upper 9,90 1,6 11,5 11,40 1,8 13,2 12,85 2,1 14,9 14,35 2,3 16,6
0. Abdomen w/GD 0 00 00 0 50 50 0 00 50 0 00 50
3 MRI Upper Abd. / 9,90 1,2 11,1 11,40 1,4 12,8 12,85 1,5 14,4 14,35 1,7 16,1
1. Adrenal w/GD 0 00 00 0 00 00 0 50 00 0 50 00
3 MRI Upper Abd. 9,90 3,6 13,5 11,40 4,1 15,5 12,85 4,7 17,5 14,35 5,2 19,5
2. And MRCP w/GD 0 00 00 0 50 50 0 00 50 0 00 50
3 MRI Lower Abd. 9,50 1,2 10,7 10,95 1,4 12,3 12,35 1,5 13,9 13,80 1,7 15,5
3. Plain 0 00 00 0 00 50 0 50 00 0 50 50
3 MRI Lower Abd. 9,90 1,2 11,1 11,40 1,4 12,8 12,85 1,5 14,4 14,35 1,7 16,1
4. w/GD 0 00 00 0 00 00 0 50 00 0 50 00
3 MRI Whole 11,3 2,4 13,7 13,00 2,7 15,7 14,70 3,1 17,8 16,40 3,5 19,9
5. Abdomen Plain 00 00 00 0 50 50 0 00 00 0 00 00
3 MRI Whole 11,6 2,4 14,0 13,35 2,7 16,1 15,10 3,1 18,2 16,80 3,5 20,3
6. Abdomen w/GD 00 00 00 0 50 00 0 00 00 0 00 00
3 MRI Whole Abd. 11,6 4,8 16,4 13,35 5,5 18,8 15,10 6,2 21,3 16,80 6,9 23,7
7. And MRCP w/GD 00 00 00 0 00 50 0 50 50 0 50 50
3 7,26 1,2 8,46 1,4 9,75 1,5 11,0 10,50 1,7 12,2
8. MRI Cervical Spine 0 00 0 8,350 00 0 9,450 50 00 0 50 50
3 7,26 1,2 8,46 1,4 9,75 1,5 11,0 10,50 1,7 12,2
9. MRI Thoracic Spine 0 00 0 8,350 00 0 9,450 50 00 0 50 50
4 MRI Lumbar / 7,26 1,2 8,46 1,4 9,75 1,5 11,0 10,50 1,7 12,2
0. Sacral Spine 0 00 0 8,350 00 0 9,450 50 00 0 50 50
4 14,7 3,6 18,3 16,90 4,1 21,0 19,10 4,7 23,8 21,30 5,2 26,5
1. MRI Whole Spine 00 00 00 0 50 50 0 00 00 0 00 00
4 MRI Cervico- 13,4 2,4 15,8 15,40 2,7 18,1 17,40 3,1 20,5 19,45 3,5 22,9
2. Thoracic Spine 00 00 00 0 50 50 0 00 00 0 00 50
4 MRI Thoracic- 13,4 2,4 15,8 15,40 2,7 18,1 17,40 3,1 20,5 19,45 3,5 22,9
3. Lumbar Spine 00 00 00 0 50 50 0 00 00 0 00 50
4 9,50 2,4 11,9 10,95 2,7 13,7 12,35 3,1 15,4 13,80 3,5 17,3
4. MRI Hip Joints 0 00 00 0 50 00 0 00 50 0 00 00
4 13,4 5,0 18,4 15,40 5,7 21,1 17,40 6,5 23,9 19,45 7,2 26,7
5. MRI Cardiac Plain 00 00 00 0 50 50 0 00 00 0 50 00
4 13,4 5,0 18,4 15,40 5,7 21,1 17,40 6,5 23,9 19,45 7,2 26,7
6. MRI Cardiac w/GD 00 00 00 0 50 50 0 00 00 0 50 00
4 7,26 1,2 8,46 1,4 9,75 1,5 11,0 10,50 1,7 12,2
7. MRI Extremities 0 00 0 8,350 00 0 9,450 50 00 0 50 50
4 MRA Thoracic 9,50 5,0 14,5 10,95 5,7 16,7 12,35 6,5 18,8 13,80 7,2 21,0
8. Aorta 0 00 00 0 50 00 0 00 50 0 50 50
4 MRA Abdominal 9,50 5,0 14,5 10,95 5,7 16,7 12,35 6,5 18,8 13,80 7,2 21,0
9. Aorta 0 00 00 0 50 00 0 00 50 0 50 50
5 9,50 5,0 14,5 10,95 5,7 16,7 12,35 6,5 18,8 13,80 7,2 21,0
0. MRA Aorta 0 00 00 0 50 00 0 00 50 0 50 50
5 MRA Lower 14,8 5,0 19,8 17,00 5,7 22,7 19,25 6,5 25,7 21,45 7,2 28,7
1. Extremities 00 00 00 0 50 50 0 00 50 0 50 00
5 MRA Upper 14,8 5,0 19,8 17,00 5,7 22,7 19,25 6,5 25,7 21,45 7,2 28,7
2. Extremities 00 00 00 0 50 50 0 00 50 0 50 00
5 15,3 15,3 17,6 17,6 19,9 19,9 22,2 22,2
3. Coronary MRI* 50 50 50 50 50 50 50 50
5 Brachial Flexus 12,8 12,8 14,7 14,7 16,6 16,6 18,5 18,5
4. MRI* 00 00 00 00 50 50 50 50
5 12,8 12,8 14,7 14,7 16,6 16,6 18,5 18,5
5. Liver Specific Flow* 00 00 00 00 50 50 50 50
5 12,8 12,8 14,7 14,7 16,6 16,6 18,5 18,5
6. CSF Flow MRI* 00 00 00 00 50 50 50 50
Contrast and Professional Fees – to be
* charged separately
Effective November
* 8, 2019
Culture and Sensitivity Test (All specimen except blood)
Laboratory procedure which aims to cultivate, evaluate and identify clinically significant microorganisms that cause infection. A sensitivity
test gives information on what antibiotic will work best to treat the infection.

Office/Division: Laboratory Medicine Division

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s request - Doctor’s Clinic
2. OPD Card (for service patients) - Outpatient Division
3. Health Maintenance Organization (HMO) card and - HMO Provider
Letter of Authorization (LOA) (if applicable)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present doctor’s request 1. Receive doctor’s request None 20 minutes Receptionist-on-duty
and wait for name to be
called. 1.1. Instruct patient to wait for
name to be called
nd
(Window 10, 2 floor
Medical Arts Building 1.2 Register patient’s data
Annex)
1.3 Issue charge slip and/or Cashier-on-duty
forward to cashier

2. Once name is called, get 2. Call patient’s name, receive Please see 20 minutes Cashier-on-duty
charge slip and pay payment and issue official Laboratory Tests
applicable fees receipt Price List

(6am to 11:30am- Payment

Window, 2nd floor Medical
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
Arts Building Annex)

(11:30 onwards-Cashier’s
Office Basement Hospital
Building and OPD Cashier)

Make sure to keep charge

slip and get official receipt

2.1 For HMO card holders,

get charge slip from
Window 10
3. Proceed to Window 11, 3. Enter and stamp requested Official Receipt and 5 minutes Receptionist-on-duty
present charge slip and laboratory tests in the Charge slip
official receipt Laboratory Information System

3.1 Return charge slip and OR

to patient and issue number for
Blood Extraction

4. Submit specimen to 4. Receive specimen and advice 15 minutes Receptionist-on-duty

Receiving Window on releasing of results
(Mezzanine MAB Annex) Medical Technologist-on
4.1 Conduct Laboratory Test duty
procedure

6. Claim official result Release official result None 4 days Staff-on-duty

Consult your doctor for interpretation of results
Total None 4 days and 1 hour
End of Transaction
DIAGNOSTIC PACKAGES (OUT-PATIENT)

The Wellness Clinic offers discounted rates on various diagnostic (routine) laboratory procedures to all patients as indicated in the
brochure. Discounted rates for government employees, senior citizen & Persons with Disability shall be rendered only to optional
procedures. ID cards and certificate of employment for government employees shall be presented to the cashier office upon
payment.

Office/Division: Wellness Clinic

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Physician’s Request (1 original copy) - Doctor’s Clinic

2. Service Issue Slip (SIS), if payment - Social Service Division, Ground Floor – Annex Bldg.
is through financial assistance
3. Charge slips & Diagnostic procedural - Wellness Clinic – Room 515 (5th floor, Medical Arts Bldg.)
filled-out forms - Cashier Office (OPD Annex bldg. Ground floor/ laboratory Medicine 2nd floor
4. Official receipt of payment Annex bldg. / cashier satellite – in front of Information / Pharmacy, 4th floor
Medical Arts bldg.)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Fill out forms and 1. Entertain client and
sign applicable check doctor’s written None 20 minutes Clerk or Medical Technologist
document at the request for diagnostic
reception area of procedures
Wellness Clinic, Reception area, Room 515 (5th
Room 515 (5th floor, 1.1 Determine floor, Medical Arts Bldg.)
Medical Arts Bldg.) package to avail

1.2 Register name &

through MedTrak

1.3 Issues charge slips

 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Receive charge 2. Escort patient to the Depends on the
slips and pay cashier diagnostic package 20 minutes Cashier on duty
applicable fees at and optional tests, if
the Cashier office 2.1 Record the official applicable
receipt number

3. Proceed to 3. Escort patient to the None 4 hours Clerk or Medical Technologist

concerned concerned diagnostic
diagnostic center laboratories Note: patients are queued for Diagnostic areas
each tests/ procedures
3.1 Give advice
patient/companion to
get official results at the
Wellness Clinic, Room
515 (5th floor, Medical
Arts Bldg.)

3.2 Advise patient to

proceed to doctor for
interpretation of results
4. Receive official 4. Collect official results None 3 days Clerk or Medical Technologist
results at the from concerned
Wellness Clinic and diagnostic center. Note: after finishing steps 1 to Room 515 (5th floor, Medical
proceed for 3 Arts Bldg.)
interpretation of
results at the
doctor’s clinic.
3 days for Walk-In
None
Total patients
End of Transaction
CUSTOMIZED DIAGNOSTIC PACKAGES FOR GOVERNMENT AGENCIES

The Wellness Clinic offers customized diagnostic (routine) laboratory procedures on discounted rates to government agencies with
Memorandum of Agreement. Optional tests not included in the referral form shall be paid by the employee depending on the
guidelines proposed by the concerned agency if it exceeds in the allotted budget.

Office/Division: Wellness Clinic

Classification: Simple
Type of Transaction: G2G Government to Government
Who may avail: Government agencies with approved Memorandum of Agreement
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral form from the agency - Concerned government agency
(1 original copy)
2. Service Issue Slip (SIS), if payment is through - Social Service Division, Ground Floor – Annex Bldg.
financial assistance - Wellness Clinic – Room 515 (5th floor, Medical Arts Bldg.)
3. Diagnostic procedural filled-out forms - Cashier Office (OPD Annex bldg. /laboratory Medicine)
4. Charge slips (in case excess in allotted budget by
the agency)
5. Official receipt of payment, if applicable
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Fill out forms and sign 1. Check referral form for None 15 minutes
applicable document at optional diagnostic Clerk or Medical
the reception area of procedures Technologist
Wellness Clinic, Room
515 (5th floor, Medical 1.1 Inform patient on fees Reception area, Room 515
Arts Bldg.) for optional tests (5th floor, Medical Arts Bldg.)

1.2 Register name through

MedTrak

1.3 Issues charge slips for

optional procedures, if
applicable
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Pay applicable fees 2. Escort patient to the Depends on the 20 minutes Cashier on duty
at the laboratory cashier, if applicable diagnostic package
Medicine cashier/OPD *Diagnostic procedures Cashier Office (OPD
cashier 2.1 Record the official varies yearly cashier/laboratory medicine,
receipt number depending on the 2nd floor Annex bldg.)
Note: Applicable only to needs &/or required by
clients with optional tests the agency.
request which exceeds
allocated budget
3. Proceed to concerned 3. Escort patient to the None 4 hours Clerk or Medical
diagnostic center concerned diagnostic Technologist
laboratories Note: patients are queued
for each tests/ procedures Diagnostic areas

4. Fill out annual 4. Prepare official & None 5 minutes Clerk or Medical
physical exam and preliminary results to Technologist
summary report forms at Medical House staff for
the Wellness Clinic, consultation Reception area, Room 515
Room 515 (5th floor, (5th floor, Medical Arts Bldg.)
Medical Arts Bldg.) 4.1 Clerk or Medical
Technologist collects all
preliminary &/or official
results from various
laboratories

4.2 Clerk or Medical

Technologist inserts all
preliminary &/or official
results in each envelope
bearing the patient’s name
& name of agency
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
5. Prepare for physical 5. Clerk of Medical None 5 minutes Clerk or Medical
examination at the Technologist records vital Technologist
Wellness Clinic, Room signs from each patient.
515 (5th floor, Medical 5.1 Presents patient with Reception area, Room 515
Arts bldg.) preliminary and official (5th floor, Medical Arts Bldg.)
results for interpretation.

6. Return for consultation 6. Adult cardiologist None 15 minutes per Rotating Adult cardiology
at Wellness Clinic, provides medical evaluation consultation per patient fellow
Room 515 (5th floor, to patient
Medical Arts Bldg.) 6.1 Interprets official and Reception area, Room 515
preliminary results (5th floor, Medical Arts Bldg.)
Note: Official results shall be 6.2 Provides health
collected by the agency's education and summary
liaison officer at the
report
Wellness Clinic (Room 515,
5th floor Medical Arts Bldg.)
6.3 Prescribe medications, if
necessary

6.4 Proof reads and affix

signature on each patient’s
summary report.
1 day for government
Total None
employees with MOA
End of Transaction
 PHILIPPINE HEART CENTER
Wellness Clinic
Out – Patient Diagnostic Packages
December 03, 2018

1. Hypertension Package

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Fasting Blood Sugar 285.00
Creatinine 285.00
Uric Acid 285.00
Routine Urinalysis 235.00
Electrocardiogram 460.00 90.00
Chest X-Ray (PA/LAT) 600.00 135.00
Lipid Profile 1,285.00
TOTAL 3,885.00 225.00 3,700.00

2. Diabetes Package

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Fasting Blood Sugar 285.00

Glycosylated Hemoglobon (HbAIC) 1,060.00
Creatinine 285.00
SGPT/ALT 300.00
Lipid Profile 1,285.00
Micral Test/Micro Albumin 225.00
Routine Urinalysis 235.00
TOTAL 3,675.00 0.00 3,300.00
3. Dyslipidemia Package

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Fasting Blood Sugar 285.00
SGPT/ALT 300.00
Uric Acid 285.00
Lipid Profile 1,285.00
TOTAL 2,605.00 0.00 2,350.00

4. Cardio Pulmonary Package I

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

2-D Echo cardiogram with Doppler 3,580.00 640.00

Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 4,180.00 775.00 4,500.00

5. Cardio Pulmonary Package II

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Electrocardiogram 460.00 90.00

2-D Echo cardiogram with Doppler 3,580.00 640.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 4,640.00 865.00 4,950.00
6. Cardio Pulmonary Package III

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Routine Urinalysis 235.00
Electrocardiogram 460.00 90.00
2-D Echo cardiogram with Doppler 3,580.00 640.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 5,325.00 865.00 5,550.00

7. Cardio Pulmonary Package IV

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Fasting Blood Sugar 285.00
Lipid Profile 1,285.00
Creatinine 285.00
Uric Acid 285.00
Routine Urinalysis 235.00
2-D Echo cardiogram with Doppler 3,580.00 640.00
Chest X-Ray (PA/LAT) 600.00 135.00
Pulmonary Function Test 930.00 130.00
TOTAL 7,935.00 905.00 7,950.00
8. Cardio Pulmonary Package V

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Fasting Blood Sugar 285.00
Lipid Profile 1,285.00
Creatinine 285.00
Uric Acid 285.00
SGPT/ALT 300.00
Routine Urinalysis 235.00
2-D Echo cardiogram with Doppler 3,580.00 640.00
Treadmill Exercise Test 1,640.00 295.00
Chest X-Ray (PA/LAT) 600.00 135.00
Pulmonary Function Test 930.00 130.00
TOTAL 9,875.00 1,200.00 9,950.00

9. Heart Package I

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Electrocardiogram 460.00 90.00

2-D Echo cardiogram with Doppler 3,580.00 640.00
TOTAL 4,040.00 730.00 4,300.00
10. Heart Package II

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Electrocardiogram 460.00 90.00

2-D Echo cardiogram with Doppler 3,580.00 640.00
Treadmill Exercise Test 1,640.00 295.00
TOTAL 5,680.00 1,025.00 6,050.00

11. Mini Adult Package

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Fasting Blood Sugar 285.00

Lipid Profile 1,285.00
TOTAL 1,570.00 0.00 1,400.00

12. Basic Adult Package

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Fasting Blood Sugar 285.00
Lipid Profile 1,285.00
Routine Urinalysis 235.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 2,855.00 135.00 2,700.00
13. Basic Pre-Employment Package

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Routine Urinalysis 235.00
Chest X-Ray (PA) 480.00 110.00
TOTAL 1,165.00 110.00 1,150.00

14. Pre-Employment Package I

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Routine Urinalysis 235.00
Chest X-Ray (PA) 480.00 110.00
Drug Test 250.00
TOTAL 1,415.00 110.00 1,370.00

15. Pre-Employment Package II

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Fasting Blood Sugar 285.00

Complete Blood Count 450.00
Routine Urinalysis 235.00
Routine Fecalysis 135.00
Blood Typing 350.00
Chest X-Ray (PA) 480.00 110.00
Drug Test 250.00
TOTAL 2,185.00 110.00 2,050.00

16. Pre-Employment Package III

 HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Fasting Blood Sugar 285.00

Complete Blood Count 450.00
Routine Urinalysis 235.00
Routine Fecalysis 135.00
Blood Typing 350.00
Chest X-Ray (PA) 480.00 110.00
Electrocardiogram 460.00 90.00
Drug Test 250.00
TOTAL 2,645.00 200.00 2,550.00

17. Health Assessment I

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Fasting Blood Sugar 285.00
Lipid Profile 1,285.00
Creatinine 285.00
Uric Acid 285.00
SGPT/ALT 300.00
Routine Urinalysis 235.00
Chest X-Ray (PA/LAT) 600.00 135.00
Ultrasound (Whole Abdomen) 2,840.00 875.00
Electrocardiogram 460.00 90.00
SUB-TOTAL 7,025.00 1,100.00
Consultation w/ Physician 600.00
TOTAL 7,025.00 1,700.00 7,900.00

18. Health Assessment II

PROCEDURES HOSPITAL READERS' FEES PACKAGE RATE
 CHARGES

2-D Echo cardiogram with Doppler 3,580.00 640.00

Treadmill Exercise Test 1,640.00 295.00
Pulmonary Function Test 930.00 130.00
Nutrition Consultation 500.00
TOTAL 6,150.00 1,565.00 6,950.00

19. Health Assessment III

A. Male above 40 years old

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Prostate Specific Antigen (PSA) 1,700.00

Prostate Ultrasound (UB/Prostate) 850.00 245.00
TOTAL 2,550.00 245.00 2,500.00

B. Female above 40 years old

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Ultrasound (Breast) 910.00 280.00

Pap's Smear 200.00 400.00
TOTAL 1,110.00 680.00
Collection of Specimen by OB-Gyne 500.00
TOTAL 1,110.00 1,180.00 2,150.00

C. Female above 40 years old

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Bone Densitomery (Routine) 2,500.00 1,000.00

 Ultrasound (Breast) 910.00 280.00
Pap's Smear 200.00 400.00
TOTAL 3,610.00 1,680.00
Collection of Specimen by OB-Gyne 500.00
TOTAL 3,610.00 2,180.00 5,400.00

20. Health Assessment IV

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Complete Blood Count 450.00

Fasting Blood Sugar 285.00
Lipid Profile 1,285.00
Creatinine 285.00
Uric Acid 285.00
SGPT/ALT 300.00
Routine Urinalysis 235.00
Electrocardiogram 460.00 90.00
Chest X-Ray (PA/LAT) 600.00 135.00
SUB-TOTAL 4,185.00 225.00
Check-Up Consultation w/ Physician 500.00
TOTAL 4,185.00 725.00 4,450.00

21. Health Assessment V (Senior Citizen/Government Employee)

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES
 Complete Blood Count 450.00
Fasting Blood Sugar 285.00
Lipid Profile 1,285.00
Creatinine 285.00
Uric Acid 285.00
SGPT/ALT 300.00
Routine Urinalysis 235.00
Electrocardiogram 460.00 90.00
Chest X-Ray (PA/LAT) 600.00 135.00
SUB-TOTAL 4,185.00 225.00
Consultation w/ Physician 500.00
TOTAL 4,185.00 725.00 4,000.00

22. Health Assessment VI (Senior Citizen/Government Employee)

A. Male
HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Prostate Specific Antigen (PSA) 1,700.00

Prostate Ultrasound (UB/Prostate) 850.00 245.00
TOTAL 2,550.00 245.00 2,200.00

B. Female

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Ultrasound (Breast) 910.00 280.00

Pap's Smear 200.00 400.00
SUB-TOTAL 1,110.00 680.00
 Collection of Specimen by OB-Gyne 500.00
TOTAL 1,110.00 1,180.00 1,900.00

C. Female (with bone densitometry)

HOSPITAL
PROCEDURES READERS' FEES PACKAGE RATE
CHARGES

Bone Densitometry (Routine) 2,500.00 1,000.00

Ultrasound (Breast) 910.00 280.00
Pap's Smear 200.00 400.00
SUB-TOTAL 3,610.00 1,680.00
Collection of Specimen by OB-Gyne 500.00
TOTAL 3,610.00 2,180.00 4,700.00
Discharge of Service Patients at Emergency Room (ER)
Process by which a service patient who consulted at the ER is discharged either after medical treatment or is transferred to another
health facility for continuity of care or is discharged against medical advice due to patient/family's personal reasons.
Office/Division: Ambulatory Care Division/Social Service Division
Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All indigent/poor patients with cardiac and other cardiac related diseases
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Notice of Discharge Emergency Room Charge Nurse

Hospital Bill Billing Section, Basement Medical Arts Building

OPD Card, if applicable Social Service Division

If No Balance Billing (NBB)

Philhealth pertinent documents :
CSF Billing Section, Basement Medical Arts Building
CF4 and photocopy of diagnostic results ER Charge Nurse
Member Data Record (MDR) Philhealth Office
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Receive verbal order of 1. Inform patient of discharge None 3 minutes Charge Nurse
discharge
1.1 Prepare notice of
1.1 Verify Doctor’s Order, discharge
submit notice of
discharge and Philhealth 1.2 Instruct to proceed to
forms to Billing Section Billing Section, submit None 5 minutes Social Welfare Officer I/II
Philhealth forms and get
statement of account

Emergency Room,
Social Services Division Office
Basement, Medical Arts
Building Annex
Drug Testing
To determine the presence or absence of a specified parent drugs or their metabolites such as methamphetamine and tetrahydrocannabinol in
the urine.

Office/Division: Blood Bank

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor's Request/Pre- Employment Institution requirement / - Doctor's Clinic, Requesting establishment
Institution's request (1original copy)
2. Identification Card (original copy)-government or non-government
issued ID, - Client (owner)

Any of the following: PRC,SSS, GSIS, Company ID, Passport,

School ID , Philhealth, Driver's License,TIN, Postal ID,Voter's IID,
Senior Citizen's ID, OFW ID &PAG-IBIG ID
3. If client is unavailable for claiming result, Present Official Receipt
or Authorization letter

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
 1. Present Doctor's request, 1. Receive and check the None 30 minutes Clerk
fill out and submit Custody CCF-A,B, C and Form DT-
Control Form- A,B & C with 001 if completely filled up
Form DT-001) together with 1.1 Process registration and
requirements issue charge slip

(Blood Bank Reception 1.2 Instruct to pay at the

Area MAB Annex Building- cashier and come back with
Mezzanine, 2nd Floor) Official Receipt

2. Pay applicable fee

Cashier's Office (MAB Annex 2. Receive payment and
Building) – Mezzanine, 2nd issue Official Receipt (OR) 250.00 30 minutes Cashier
Floor Laboratory Medicine
Division Window 10
(6:00am – 11:30am);

Ground floor
Window 8 & 9
( 6:00am – 7:00pm);
Hospital building lobby
( 24/7) ; MAB Basement
( 8:00am – 8:00pm)

Make sure to get official receipt

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Present Official receipt to 3. Double check necessary None 30 minutes Clerk
Blood Bank Reception Area
requirements and Set up
and wait for name to be called
(Blood Bank Reception Area area for Drug Testing
MAB Annex Building-
Mezzanine, 2nd Floor) 3.1 Label urine Sample Cup
properly

3.2 Encode data of client at

Integrated Drug Test
Operation and Management
Information System
(IDTOMIS) and call client for
Drug Test

4. Double check and verify all 4. Clerk shows encoded data None 10 minutes Clerk
the data encoded by the Clerk and assist client for picture
on the computer and finger print scanning

(Blood Bank Reception Area

(MAB Annex Building-
Mezzanine, 2nd Floor)

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
5. Present Valid ID for 5. Give urine sample cup None 5 minutes Clerk
verification, prepare for picture (with proper label) to client for
and finger print scanning collection of urine sample
(Blood Bank Reception Area, 60ml and assist client on
MAB Annex Building- designated Comfort room
Mezzanine, 2nd Floor)

6. Collect at least 60 ml urine 6. Receive and check urine None 45 minutes Clerk
sample and submit to Clerk in- sample integrity and
charge (Blood Bank Reception adequacy .
Area, MAB Annex Building-
Mezzanine, 2nd Floor)
7. Seal the sample cup with 7. Submit the urine sample None 10 minutes Clerk
own signature (Blood Bank with the client's documents at
Reception Area, MAB Annex drug testing area
Building- Mezzanine, 2nd Floor) 1 hour Drug Analyst
7.1 Perform drug testing and
instruct client to come back
for the result

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
 8. Present Official Receipt and 8. Analyst upload results at None Drug Analyst
claim result at the reception the IDTOMIS program and
area and present to the print the official results
attending/referring
Physician/Requesting 8.1 If Drug test result is
establishment Positive, do confirmatory
drug testing at National
Note: Reference Laboratory (NRL) P 1,000.00 20 working days Clerk or Drug Analyst

If Drug test result is Positive, 8.2. If result is negative it will (To be paid by the
wait for confirmatory drug be released the following day Philippine Heart
testing result Center)
1 day Clerk
(Blood Bank Reception Area
(MAB Annex Building-
Mezzanine, 2nd Floor)
9. Claim result on scheduled 9. Issue the official result and None 15 minutes Clerk
date ask client to sign in the
logbook
(Blood Bank Reception Area
(MAB Annex Building-
Mezzanine, 2nd Floor)
Consult your doctor for interpretation of results
Total P250.00 If positive:
21 working days
If negative:1 day
End of Transaction
Electrodiagnosis
Electrodiagnosis is administered to patients who require further testing to determine the status of their nerves. This test is able to determine
the extent of the injury, the location of the lesion, and the specific nerve affected. The test guides the physiatrists in making more
comprehensive clinical decisions with regards to patient management.

Office/Division: Physical Medicine and Rehabilitation Division

Classification: Simple
Type of Transaction: G2C: Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Request of procedure - Referring Physician / Doctor’s Clinic

( 1 original copy)
2. Official Receipt - Cashier’s Office

If payment is through financial assistance/insurance/inter-

agency
1. Social Service Issue Slip - PHC Social Service Division
2. Health Maintenance Organization (HMO) Letter of - HMO Coordinator
Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present doctor’s request 1. Verify request and instruct
for procedure with patient to fill-out None 10 minutes Rehab Receptionist
patient’s contact details necessary contact
at PMRD Reception (8th information
Fl MAB) 1.1. Categorize request Reception Area, PMRD
if for 1-2
extremities or 3-4
extremities
1.2. Register patient in
the system
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.3. Issue charge slip
1.4. Instruct patient to
pay at the Cashier
2. Pay applicable fees at 2. Receive payment for the
the Cashier’s Office (4th procedure and issue See Table of Fees 20 minutes Cashier
floor MAB, Basement official receipt
MAB) and get official
receipt.
Cashier’s Office
3. Present Official receipt 3. Receive official receipt
at the PMRD Reception and log the OR number in None 10 minutes Rehab Receptionist
(8th Fl, MAB) the logbook

Reception Area, PMRD

4. Wait for name to be 4. Instruct patient to wait Rehab Receptionist
called for the procedure None 30 minutes
(8th Fl, MAB) Reception Area, PMRD
5. Submit self for the 5.Perform the test
procedure at the 5.1. Explain procedure None 1 hour, 15 minutes Electromyographer
Electromyography- and have the (Dr. B. Fidel)
Nerve Conduction patient sign the
Velocity Test Room (8th informed consent
Fl, MAB) 5.2. Perform
Electromyography- Electromyography-Nerve
Nerve Conduction Conduction Velocity Test
Velocity Test (EMG-NCV) Room, PMRD
5.3. Prepare diagnostic
results
6. Wait for the results at 6. Instruct patient to wait for Rehab Receptionist
the reception area the results None 20 minutes
Reception Area, PMRD
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
7. Claim result and consult 7.Give the patient result of the Electromyographer
your doctor for test and explain the result of None 10 minutes (Dr. B. Fidel)
interpretation of results the test to the patient
Electromyography-Nerve
Conduction Velocity Test
(EMG-NCV) Room, PMRD
Total See Table of Fees 2 hours, 55 minutes
Electroencephalogram (EEG) Requests Process
An Electroencephalogram (EEG) is a test used to evaluate the electrical activity in the brain. The test is used to help diagnose epilepsy.
It can be used also to evaluate conditions such as head injuries, dizziness, headaches, brain tumor, sleeping problems and patients with
disorders of consciousness. It can also be used to confirm brain death.

Office/Division: Neurology Section

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request of procedure - Doctor’s Clinic

If payment is through financial assistance/ Insurance:

1. Service Issue Slip - Social Services Division
2. Inter-Agency (3 copies- 1 original and 2 - other hospital or government agencies
photocopies)
3. Letter of Authorization (LOA) from Health - HMO Coordinator
Maintenance Organization (HMO) - 1 original
copy
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Get schedule for EEG 1. Log and give None 10 minutes Med. Tech. I or Med.
instructions Tech. II
1.1. Present doctor's request for for procedure Neurology Section / EEG
schedule at EEG Lab. 4th Flr. Lab.
Hospital Bldg. or call 8925-2401
local 2456
2. Come on the 2. Give request form if None 10 minutes Med. Tech. I or Med.
scheduled date and applicable and instruct Tech. II
time patient to fill out pertinent Neurology Section / EEG
data Lab.
2.1. Fill out patient's data on
request form and submit to 2.1. Encode data and
technician on duty provide charge slip to
patient
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Pay applicable fees 3. Receive payment and Correspondi- 30 minutes Cashier I or Cashier II
for EEG procedure issue Official Receipt ng fees for the
and Reader's Fee (O.R.) procedure requested Cashier's Office
and get O.R. at the Ground Floor lobby or
hospital cashier in Basement
Ground Floor lobby
or Basement
4. Present copy of 4. Record O.R. #, perform None Routine EEG- 1 hour Med. Tech. I or Med.
Official Receipt (OR) to EEG and gather patient's and 15 mins. Tech. II
technician on duty history
and cooperate for 1 Hr. Awake and Neurology Section / EEG
the EEG procedure Sleep- 2 hours Lab.
at the EEG Lab. 4th
Flr. Hospital Bldg. 2 Hrs. Video EEG- 3.5
Hrs.

4 Hrs. Video EEG- 5.5

Hrs.

6 Hrs. Video EEG- 7.5

Hrs.

8 Hrs. Video EEG- 9.5

Hrs.
5. Claim official result Release official result None 3 days Med. Tech. I or Med.
Tech. II

Neurology Sec./EEG Lab.

Consult your doctor for interpretation of results
 Total See table of Fees
End of Transaction

PHILIPPINE HEART CENTER

NEUROLOGY SECTION

RATES – AUGUST 1, 2018

Patients in Semi-
Patients in OPD, Private Patients in Private
Patient
Emergency Room (ER) Rooms including Rooms including s
PROCEDURE Service and Pay Wards Semi-Private Rooms in Private Rooms in in
Suite
SICU/MICU/CCU/PICU SICU/MICU/CCU/PICU Rooms
NICU/Isolation Rooms
Hospita TOTA Hospita TOTA Hospita TOTA Hospita TOTA
l PF L l PF L l PF L l PF L

1 Routine EEG (Station, No Video) 2,300 700 3,000 2,650 700 3,350 3,000 700 3,700 3,350 700 4,050
30 min. recording awake and drowsy

2 Routine EEG (Station, with Video) 2,800 700 3,500 3,200 700 3,900 3,650 700 4,350 4,060 700 4,760
30 min. recording awake and drowsy

3 Routine EEG (Bedside, No Video) 2,750 700 3,450 3,150 700 3,850 3,600 700 4,300 4,000 700 4,700

4 Routine EEG (Bedside, with Video) 3,250 700 3,950 3,750 700 4,450 4,250 700 4,950 4,700 700 5,400

Awake & sleep/ Sleep deprived 1,00 1,00 1,00

5 (Station, No Video) 3,500 0 4,500 4,050 0 5,050 4,550 0 5,550 5,100 1,000 6,100
(minimum of 1 hr. with additional
P1,000
exceeding 1 hr.)

Awake & sleep/ Sleep deprived 1,00 1,00 1,00

6 (Station, with Video) 4,300 0 5,300 4,950 0 5,950 5,600 0 6,600 6,250 1,000 7,250
 (minimum of 1 hr. with additional
P1,000
exceeding 1 hr.)

Awake & sleep/ Sleep deprived 1,00 1,00 1,00

7 (Bedside, No Video) 4,200 0 5,200 4,850 0 5,850 5,450 0 6,450 6,100 1,000 7,100
(minimum of 1 hr. with additional
P1,000
exceeding 1 hr.)
Awake & sleep/ Sleep deprived 1,00 1,00 1,00
8 (Bedside, with Video) 5,000 0 6,000 5,750 0 6,750 6,500 0 7,500 7,250 1,000 8,250
(minimum of 1 hr. with additional
P1,000
exceeding 1 hr.)

Electrocerebral Silence/Comatose 1,00 1,00 1,00

9 Protocol (Bedside) 4,400 0 5,400 5,050 0 6,050 5,700 0 6,700 6,400 1,000 7,400
(1 hour recording)

1 Video EEG/Epilepsy monitoring 2,00 2,00 2,00

0 (Station, with Video) 5,400 0 7,400 6,200 0 8,200 7,000 0 9,000 7,850 2,000 9,850
2 hrs. recording

1 Video EEG/Epilepsy monitoring 2,00 2,00 2,00

1 (Bedside with Video) 6,400 0 8,400 7,350 0 9,350 8,300 0 10,300 9,300 2,000 11,300
2 hrs. recording

1 Video EEG/Epilepsy monitoring 3,50 3,50 3,50

2 (Station, with Video) 7,000 0 10,500 8,050 0 11,550 9,100 0 12,600 10,150 3,500 13,650
4 hrs. recording

1 Video EEG/Epilepsy monitoring 3,50 3,50 3,50

3 (Bedside with Video) 9,000 0 12,500 10,350 0 13,850 11,700 0 15,200 13,050 3,500 16,550
4 hrs. recording

1 Video EEG/Epilepsy monitoring 5,00 5,00 5,00

4 (Station, with Video) 8,800 0 13,800 10,100 0 15,100 11,450 0 16,450 12,750 5,000 17,750
6 hrs. recording

1 Video EEG/Epilepsy monitoring 6,50 6,50 6,50

5 (Station, with Video) 11,000 0 17,500 12,650 0 19,150 14,300 0 20,800 15,950 6,500 22,450
8 hrs. recording
ELECTROPHYSIOLOGY PROCEDURES (Head-Up Tilt Table Test, Cardioversion)

Head-Up Tilt Table Test- is one of the tests used to diagnose the cause of fainting spells. The patient is strapped to a
bed and tilted at 70 degrees angle and is observed for fainting while heart rate and rhythm and blood pressure are being
monitored.

Cardioversion- This procedure uses electric current to convert abnormally fast heart beats (Tachycardia) or irregular
heart beat (Atrial Fibrillation) to the normal heart rhythm.

Office/Division: Electrophysiology Division

Classification: Simple

Type of Transaction: G2C Government to Citizen

Who may avail: All

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. For private patients- Referral letter for the 1. Clinic of their Attending Physician
procedure

2. Diagnostic tests like ECG, 2D Echo, 24hour 2. Non-invasive Division, PHC MAB Ground Floor or from the
Holter if applicable hospital or diagnostic center
where the patient did these procedures
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE

1. Secure schedule for 1. Schedule patient for None 15-30 minutes EP Clerk
the procedure the procedure &inform EP Consultant
patient and EP
This is done either by Consultant EPD Office
calling or
in person.
EP Division Petal 1A
Ground Floor Hospital
Building Tel #
89252401
local 2117

2. Arrive on the day and 2. History Taking and None 30 minutes Rotating EP Fellow
time of scheduled Assessment EP CRF
procedure Attending EP
2.1 Explain the procedure
and discuss its risks and EPS Procedure Room
benefits
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE

3. Read and sign 3.Facilitate and assist the None 5 minutes EP Nurse
Consent and Waiver signing of the Consent Rotating Fellow
form for the procedure and Waiver Form EP CRF
Attending EP

EPS Procedure Room

4. Submit to pre- 4. IV Insertion None 30 minutes EP Nurse

procedural preparations Rotating EP Fellow
4.1 Attach necessary
monitors

4.2 Secure patient to Tilt

Table

5. Cooperate during 5. Perform the procedure None 1 hour 30 minutes EP staff

procedure proper for Tilt Table Test EP Rotating
Fellow
EP CRF
30 minutes Attending EP
Cardioversion
EPS Procedure Room

6. Cooperate post- 6. Remove IV line and None 15 minutes EP staff

procedure monitor

6.1 Discuss results and Attending EP

advise patient EPS Procedure Room
 6.2 Discuss the payment
process and issue charge
slip

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON

PAID TIME RESPONSIBLE

7. Pay applicable fees at 7. Receive payment and For Head-Up Tilt 30 minutes Cashier
Basement/Ground issue official receipt Table Test
Floor, Cashier’s Office
Hospital Building Procedure fee=
Php8,500.00
+
Medication= Php.
2,115.00
+
Professional fee

Make sure to get For

Official Receipt Cardioversion

Procedure fee =
Php7,000.00
Additional Php
8,000.00 if
Transcutaneous
Defibrillator Pads
will be used
+
Professional fee
For medications,
please see below
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE

7. Present Charge Slip 7. Record the OR None 5 minutes EP Clerk

and Official Receipt to number and return OR to
EP Clerk patient

8. Get Procedure Report 8.Release Procedural None 10 minutes EP CRF/ EPClerk

Summary Report Attending EP

8.1 Release Full Official 2 Days EP CRF

Report Attending EP
EP Clerk
EPS Office

For Head-Up Tilt Head-Up Tilt Table

Table Test- Php. Test=
10,615.00 2 days, 4 hours and,
+ Professional fee 6 minutes

For
Cardioversion- Cardioversion=
Php. 7,000.00 or 2 days, 3 hours and
Total
Php 15,000.00 6 minutes
(With Pads)
+
Professional Fees
and medications
Please see below
for cost of
medications

End of Transaction
Additional Cost That May be Incurred Depending on the Case:

A. Tilt Table Test

1. Isoproterenol - Php 2,115.00

B. Cardioversion
For the Medication of Cardioversion (Sedation of choice care of Electrophysiology Consultant)

1. Midazolam- Php. 147.61

2. Nalbuphine- Php. 147.13
3. Fentanyl- Php. 130.00
4. Diazepam- Php. 130.21

RATES - AUGUST 1, 2018

OPD, Private
Emergency Semi-Private Rooms Rooms/
Private
Room (ER), Including Semi-Private Rooms in
Rooms in SUITE
PROCEDURE Service and SICU/MICU/CCU/ SICU/MICU/ ROOMS
PICU/NICU/Isolation
Pay Wards Rooms CCU/PICU

Radiofrequency Ablation (RFA)

35,000
1 CONVENTIONAL 40,250 45,500 50,750
2 RFA WITH 3D MAPPING 30,000 34,500 39,000 43,500
3 Electrophysiology Study
3.1 SA & AV 23,000 26,450 29,900 33,350
3.2 SA, AV & VT 24,000 27,600 31,200 34,800
3.3 SA, AV,VT & PSVT 25,000 28,750 32,500 36,250
4 Cardioversion
4.1 with Paddles 7,000 8,050 9,100 10,150
4.2 with Defibrillator Pads 15,000 17,250 19,500 21,750
5 Head-up Tilt Table Test 8,500 9,800 11,050 12,350
6 Temporary Pacemaker Insertion 13,650 15,700 17,750 19,800
7 Reinsertion of Temporary Pacemaker 9,000 10,350 11,700 13,050
8 Repositioning of Temporary Pacemaker 7,000 8,050 9,100 10,150
9 Removal of Temporary Pacemaker 4,000 4,600 5,200 5,800
# Daily Use of Pulse Gen
SINGLE CHAMBER 1,745 2,000 2,250 2,550
DUAL CHAMBER 1,745 2,000 2,250 2,550
# Electrocardiogram (ECG) 460 530 600 665
# Pacemaker Analysis 800 900 1,050 1,150

Expendables used shall be charged accordingly depending on room accommodation.

Emergency Room Consultation
ER consult for symptoms or conditions needing immediate care or interventions.

Office/Division: Emergency Care Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Inform the Triage Fellow 1. Take vital signs and None Emergent : 5 mins Triage fellow-on-duty
and Nurse perform quick
assessment of client Urgent : 30 mins Triage nurse-on-duty

Triage Area, Emergency

Non-Urgent: 60 mins
Room, Ground Flr. Hospital
Bldg.
2. Fill-out the patient 2. Assist patient or None 5 minutes Triage clerk-on-duty
information on ER SOAP relative in filling-out forms
form Triage nurse-on-duty /

Triage Area, Emergency

Room, Ground Flr. Hospital
Bldg.
3. Cooperate in evaluation 3. Interview patient and None 30 minutes ER bedside nurse-on-duty
and management relatives. Assess patient and fellow-on-duty
Make orders and carry Emergency Room, Ground
out for treatment. Flr. Hospital Bldg.

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Cooperate in interventions 4. Request for Depending in 1 hour ER bedside nurse-on-duty
needed and follow-up diagnostics interventions needed and fellow-on-duty
assessment Emergency Room, Ground
Flr. Hospital Bldg.

5. If for discharge: 5. Process discharge ER fee: P650 1st 4 30 minutes ER nurse-on-duty

hours + P150 / hour Emergency Room, Ground
Get notice of discharge and for succeeding hours Flr. Hospital Bldg.
billing statement and pay and + other applicable
applicable fees Billing clerk and Cashier
fees (Laboratory, Billing Section and Cashier,
Pharmacy, CSS, Basement, MAB
Transport (if for
ambulance
conduction), PF (if
applicable) )

6. Present Official Receipt to 6. Log OR number, give None 15 minutes ER charge nurse-on-duty
ER and get instructions, instructions and ER nurse-on-duty
prescriptions and schedule discharge patient Emergency Room, Ground
of follow-up (for service Flr. Hospital Bldg.
patients)

3 hours and 20 minutes

Total
(for non-urgent cases)
End of Transaction

PHILIPPINE HEART CENTER

 EMERGENCY CARE DIVISION

RATES – August 1, 2018

1. Initial Consultation fee and 4-hour stay P 650.00

2. ER Stay – Succeeding charges after the first 4 hours P 150.00/hour

3. Injection Fee 150.00

4. NGT Insertion 150.00

Expendables as used will be charged as follows:

1. Drugs and Pharmaceutical Items, Narcotics, Surgical - acquisition cost + 43%

and Medical Supplies
Influenza/Hepatitis B Vaccine
This refer to vaccination of eligible PHC employees of Influenza and Hepatitis B vaccine

Office or Division: Out-Patient Divison/Infirmary (Influenza Flu/Hepatitis V Vaccine)

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: PHC Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Proceed to infirmary for Flu/Hepatitis 1. Prepare the flu vaccine None 5 minutes Nurse
vaccine, sign the consent form provided injection and consent
form

2. Cooperate with Flu/Hepa B vaccine 2. Administer Flu/Hepa None 10 minutes Nurse

Injection B. vaccine

3. Wait for instruction and for next schedule 3. Give instructions for None 5 minutes Nurse
next schecule

TOTAL None 20 minutes

End of Transaction
Forced Oscillation Technique (FOT)
A breathing test to determine diseases like bronchial asthma, chronic pulmonary disease (COPD) and other conditions that affect
breathing.

Office/Division: PULMONARY MEDICINE DIVISION/PULMONARY LABORATORY

Classification: SIMPLE
Type of Transaction G2C
Who may avail: 7 years old and above
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Doctor's request Attending Physician – Clinic Room
For service patients
 Service OPD card Social Service Division – Annex Bldg.
If payment is through financial assistance/HMO
1. Service Issue Slip (SIS) Social Service Division – Annex Bldg.
2. Health Maintenance Organization (HMO) Letter HMO Coordinator
of Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Present requirements, fill out 1. Receive requirements None 15 Minutes Clerk III
patient data slip and sign Fall Pulmonary Laboratory
Risk Prevention Consent at 1.1 Check doctor's Reception Area
Pulmonary Laboratory request
reception, Ground Floor, 1.2 Issue patient data slip
Hospital Bldg. 1.3 Interview the client
and give Fall Risk
Prevention Consent
1.4 Instruct patient to wait
for name to be called.
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
2. Cooperate during 2. Get patient height and None 30 Minutes Respiratory Therapist
performance of the procedure at weight. Pulmonary Laboratory PFT
the Pulmonary Laboratory PFT 2.1 Explain the test and Area.
area. Proper instruction.
2.2 Assist patient in the
performance of procedure.
3. Receive charge slip and pay 3. Issue charge slip FOT – 35 Minutes Clerk III
applicable fees at designated P 930.00 Pulmonary Laboratory
Cashier area. 3.1 Instruct client to pay Reader's Fee Reception area
*Hospital Lobby, near stairway, applicable fees and to – P 130.00
Monday to Fridays 8 am - 9 pm return to Pulmonary
*Basement Cashier – Monday to Laboratory reception after
Sunday 8 am – 7:30 pm payment

3.1 Secure official receipt

4. Present official receipt at 4. Receive official receipt None 5 Minutes Clerk III
Pulmonary Laboratory reception Pulmonary Laboratory
area 4.1 Release initial copy of Reception area
the test.
4.2 Instruct client to claim
result after 2 days
5. Present official receipt and 5. Release result. None 2 Days Clerk III
claim result at Pulmonary Pulmonary Laboratory
Laboratory reception area on reception area
appointed time.
Consult your doctor for interpretation of results
P 1,060.00 2 Days 1 Hour 25
Total
Minutes
End of Transaction
Fractional Exhaled Nitric Oxide (FENO)
A procedure to measure the exhaled nitric oxide to determine the degree of inflammation in the bronchial airways.

Office/Division: PULMONARY MEDICINE DIVISION/PULMONARY LABORATORY

Classification: SIMPLE
Type of Transaction G2C
Who may avail: 7 years old and above
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Doctor's request Attending Physician – Clinic Room
For service patients
 Service OPD card Social Service Division – Annex Bldg.
If payment is through financial assistance/HMO
1. Service Issue Slip (SIS) Social Service Division – Annex Bldg.
2. Health Maintenance Organization (HMO) Letter HMO Coordinator
of Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present requirements, fill out 1. Receive requirements None 15 Minutes Clerk III
patient data slip and sign Fall Pulmonary Laboratory
Risk Prevention Consent at 1.1 Check doctor's request Reception Area
Pulmonary Laboratory reception, 1.2 Issue patient data slip
Ground Floor, Hospital Bldg. 1.3 Interview the client and
give Fall Risk Prevention
Consent
1.4 Instruct patient to wait
for name to be called.
2. Perform procedure at the 2. Explain the test and give None 5 Minutes Respiratory Therapist
Pulmonary Laboratory PFT area. proper instruction. Pulmonary Laboratory PFT
Area.
2.1 Assist patient in the
performance of procedure.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Receive charge slip and pay 3. Issue charge slip Exhaled Nitric 35 Minutes Clerk III
applicable fees at designated 3.1 Instruct client to pay Oxide Pulmonary Laboratory
Cashier area. applicable fees and to Determination – Reception area
*Hospital Lobby, near stairway, return to Pulmonary P265.00
Monday to Fridays 8 am to 9 pm Laboratory reception after No Breath
*Basement Cashier – Monday to payment Mouthpiece –
Sunday 8 am – 7:30 pm P1,000.00

3.1 Secure official receipt

4. Present official receipt and 4. Receive official receipt None 10 Minutes Clerk III
claim result at Pulmonary Pulmonary Laboratory
Laboratory reception area 4.1 Release result. Reception area
Consult your doctor for interpretation of results
Total P 1,265.00 1 Hour 5 Minutes
End of Transaction
Follow-up Check-up Cardiology Clinics
This refers to follow-up check-up of adult patients with cardiovascular diseases.

Office or Division: Out-Patient Division

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: Adult patients with Cardiac Diseases
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. OPD card 1. OPD Room 5
If applicable:
2. Laboratory Results 2. Pathology Dept./ECG Room 3/Non-Invasive Cardiology

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Come back on scheduled date 1. Issue queue number, instruct patient None 5 minutes Clerk
and secure a queue number to wait for queue number to be flashed/called.

2. Once number is flashed/called proceed to 2. Receive queue number, OPD card, issue charge None 15 minutes Clerk
Room 5 General Cardio/Room 6 Specialty, slip, and register
present queue number and OPD card.

2.1. Wait for initial assessment. 2.1. Take vital signs. Nurse
3. Pay applicable fees 3. Receive charge slip and payment. Issue P200 = B 20 minutes OPD cashier
OPD Cashier Annex Bldg official receipt. P150 = C1
P100 = C2
Make sure to get official receipt. P50 = C3
P0 = D
3.1. Present official receipt and return charge 3.1. Receive charge slip, check and return Clerk
slip. official receipt.

3.2. Wait for number to be flashed/called. 3.2. Instruct patient to wait for number to be Clerk
flashed/called.
4. Once number is called/flashed, 4. Examine/ assess and analyze available laboratory None 3 hours Adult Cardio Fellow
proceed to Room 5/6 for follow-up check-up. results

4.1 Give prescription and laboratory/diagnostic

request
5. Proceed to nurse table for instructions. 5. Carry out doctor's orders, give instructions None 20 minutes Nurse
and schedule for the next follow-up.

TOTAL: 4 hours
End of Transaction
Histopathological Tests (Surgical and Cytological Tests including FNAB)
Laboratory test procedure including examination of biological tissue in order to observe the microscopic changes of diseased cells and
tissues to aid in the diagnosis and management of disease.

Office/Division: Laboratory Medicine Division

Classification: Highly Technical
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s request - Doctor’s Clinic
2. Health Maintenance Organization (HMO) card (if - HMO Provider
applicable)
If payment is through financial assistance/Insurance
1. Guarantee Letter - DOH,PCSO
2. HMO Letter of Authorization (LOA) - HMO Coordinator

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present doctor’s order- 1. Check doctor’s order, None 2 minutes Secretary/ Receptionist-on-
histopathology and/or labels on specimen and duty
cytology examination. check histopathology/
cytology request form (if
coming from radiology).

2. Fill out required 2. Address queries on None 5 minutes Secretary/ Receptionist-on-

information histopathology and/or duty
cytology request form
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Pay applicable fees 3. Enter patient’s Please see 30 minutes Secretary/ Receptionist-on-
information and laboratory Laboratory Tests Price duty
A. For cash/credit card request in the system; List
transaction: Cashier-on-duty
generate charge slip.
From 6AM-11:30AM (Mon-
Sat) Wait for charge slip, pay
fee and get official receipt

From 11:30AM-5PM (Mon-

Fri) Pay fee at OPD Cashier

From 5PM-6AM
Pay fee at Hospital Lobby
(Satellite Cashier)

B. Present LOA and wait for

3. 1 Execute charge upon
charge slip
completion of mode of
payment.
4. Give specimen, smears 4. Receive specimen/s None 2 minutes Secretary/ Receptionist-on-
duty
or 4.1 Perform FNAB
Medical Technologist-on-
Coordinate with provider if for 4.2 Conduct laboratory test 30 minutes duty
FNAB procedure. procedure
Please see Anatomic Consultant-in-charge
4.3 Read/Interpret Pathology Turnaround
laboratory test results Time
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
5. Claim results 5. Release results None 3 minutes Secretary/ Receptionist-on-
duty
Consult your doctor for interpretation of results
None See Anatomic
Total Pathology Turnaround
Time
End of Transaction
HIV TESTING
Used to detect the presence of the human Immunodeficiency Virus, the virus that causes Acquired Immunodeficiency Syndrome (AIDS), in
serum or plasma.

Office/Division: Blood Bank

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor's request (1 original copy) - Doctor's clinic
2. OPD Card (1 original copy) -for service patients - Philippine Heart Center -Social Service
3. HIV consent form (original copy) other - Blood Bank
form: DOH NEC form A

If payment is through financial assistance/Insurance

1. Health Maintenance Organization (HMO) Letter of
Authorization (LOA)
- HMO Coordinator
2. Guarantee Letter
- DOH

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present doctor's order 1. Check Doctor's request None 5 minutes Clerk or Medical Technologist
(Blood Bank reception
area, window 14, MAB 1.1 Provide HIV consent
Annex mezzanine) and DOH NEC form A

2. Fill up DOH NEC Form 2. Check DOH NEC Form None 20 minutes Medical Technologist
A, read and sign the HIV A and HIV consent
consent
2.1 Process registration
(Blood Bank reception and issue charge slip
area, window 14, MAB (request slip)
Annex mezzanine)

3. Proceed to counselling 3. Conduct Pre-counselling None 25 minutes Trained Counsellor or HACT

area (for pre- counselling) Team
(Blood Bank reception
counselling area, window 3.1 Instruct patient to pay
14, MAB Annex at the cashier and come Clerk
mezzanine) back with Official receipt

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
 4. Pay applicable fees 4. Receive payment and P 850.00 30 minutes Cashier
issue official receipt
Cashier's Office

MAB Annex Building –

Mezzanine, 2nd Floor
Laboratory Medicine
Division Window 10
(6:00am – 11:30am);
Ground floor
Window 8 & 9
( 6:00am – 7:00pm);
Hospital building
lobby( 24/7) ; MAB
Basement
( 8:00am – 8:00pm)

Make sure to get official

receipt

5. Present copy of Official 5. Record official receipt None 2 minutes Clerk or Medical Technologist
Receipt (Blood Bank number.
reception area, window
14, MAB Annex 5.1 Instruct patient to
mezzanine) proceed to extraction
area for blood extraction
 6. Proceed to blood 6. Check the request, None 1 day Medical Technologist
extraction area official receipt and extract
(Blood Bank extraction blood sample ( 2 pieces
area, window 14, MAB red top ) for HIV testing
Annex mezzanine) and inform client the time
or day when the
procedure will be
completed.

7. Claim result 7. Issue result and ask None 2 minutes Clerk/Medical Technologist
(Blood Bank reception client to sign in the
area, window 14, MAB logbook
Annex mezzanine)

8. Proceed to 8. Conduct post- None 20 minutes Trained Counsellor or HACT

counselling area for post- counselling Team
counselling
(Blood Bank reception
area, window 14, MAB
Annex mezzanine)

Consult your Doctor for interpretation of result.

Total P 250.00 1 Day and 1
hour & 44
minutes

End of Transaction
Indirect Calorimetry
A measurement of resting metabolic rate from Oxygen consumption and Carbon Dioxide production.

Office/Division: Pulmonary Medicine Division/Pulmonary Rehabilitation Unit

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Ages 9 years old To 85 years old
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request of Procedure ( 1 original copy) Doctor's clinic

If payment is through financial assistance;

1.Service Issue Slip –Social

Service Division
2.Guarantee Letter –HMO Coordinator

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE

PAID TIME
1.Present requirements 1. Receive None 5 minutes RT Coordinator
and get a schedule of requirements CRF
procedure at the Pulmonary Rehabilitation Unit
pulmonary rehabilitation 1.1. Instruct patient about Reception area
reception area MAB 8th the procedure
floor
1.2. Schedule patient if
there's no available slot

2. Fill-out information sheet 2. Assist client in None 10 minutes RT Coordinator

and consent form filling out forms CRF
Pulmonary Rehabilitation Unit
2.1. Get vital signs Reception area
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
3. Receive charge slip and 3. Issue charge slip Procedure 30 minutes RT Coordinator
pay applicable fees at P 2,300.00 Pulmonary Rehabilitation Unit
Cashier's office ground 3.1. Receive Reception area
floor lobby or Basement payment and
Cashier 1 or 2
Make sure to get OR issue Official
Cashier's office GF lobby
receipt (OR) or Basement

4. Present official receipt 4. Record patient data None 5 minutes RT Coordinator

and OR number CRF
Pulmonary Rehabilitation Unit
Reception area

5. Cooperate in 5. Assist patient in the None 30 minutes RT Coordinator

performance during performance of the CRF
procedure procedure Pulmonary Rehabilitation Unit
Reception area

6. Claim result 6. Release of result None 5 minutes CRF

P 2,300.00 1 hour and 25

Total
minutes
End of Transaction
Inhalation Therapy
Treatment done to reduce pulmonary symptoms like shortness of breathing.

Office/Division: PULMONARY MEDICINE DIVISION/PULMONARY LABORATORY

Classification: SIMPLE
Type of Transaction G2C
Who may avail: ALL
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Doctor's request Attending Physician – Clinic Room
For service patients
 Service OPD card Social Service Division – Annex Bldg.
If payment is through financial assistance/HMO
1. Service Issue Slip (SIS) Social Service Division – Annex Bldg.
2. Health Maintenance Organization (HMO) HMO Coordinator
Letter of Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present requirements and fill 1. Receive requirements None 15 Minutes Clerk III
out patient data slip at Pulmonary Laboratory
Pulmonary Laboratory 1.1 Check doctor's Reception Area
reception, Ground Floor, request
Hospital Bldg. 1.2 Issue patient data slip
1.3 Instruct patient to wait
for name to be called.
2. Cooperate during 2. Assist patient in the None 20 Minutes Respiratory Therapist
performance of the procedure at performance of Pulmonary Laboratory
the Pulmonary Laboratory procedure. Extraction Area
extraction area.

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Receive charge slip and pay 3. Issue charge slip *Please see table 35 Minutes Clerk
applicable fees at designated of fees below III
Cashier area. 3.1 Instruct client to pay Pulmonary Laboratory
*Hospital Lobby, near stairway, applicable fees and to Reception area
Monday to Fridays 8 am - 9 pm return to Pulmonary
*Basement Cashier – Monday to Laboratory reception after
Sunday 8 am – 7:30 pm payment

3.1 Secure official receipt

4. Present official receipt at 4. Receive official receipt None 5 Minutes Clerk III
Pulmonary Laboratory reception Pulmonary Laboratory
area. Reception Area
*Please see table 1 Hour 15 Minutes
Total
of fees below
End of Transaction

PROCEDURE, SUPPLIES AND MEDICINES TOTAL

Inhalation Therapy P 200.00 per dose

Adult nebulizer kit w/ aerosol mask P 186.00

Pedia nebulizer kit w/ aerosol mask P 200.50

Sidestream nebulizer kit P 279.00

Salbutamol P 10.00

Ipratropium P 42.00

Budesonide P 132.00
Fluticosone Propionate P 98.75

NSS P 17.00
Laboratory Tests (Blood, Urinalysis, Stool, KOH, AFB, Gram Stain)
Laboratory procedures performed on different specimen to detect presence of disease that will aid in patient management.

Office/Division: Laboratory Medicine Division

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s request - Doctor’s Clinic
2. OPD Card (for service patients) - Outpatient Division
3. Health Maintenance Organization (HMO) card and - HMO Provider
Letter of Authorization (LOA) (if applicable)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present doctor’s request 1. Receive doctor’s request None 20 minutes Receptionist-on-duty
and wait for name to be
called. 1.1. Instruct patient to wait for
name to be called
nd
(Window 10, 2 floor
Medical Arts Building 1.2 Register patient’s data
Annex)
1.3 Issue charge slip and/or Cashier-on-duty
forward to cashier

2. Once name is called, get 2. Call patient’s name, Please see 20 minutes Cashier-on-duty
charge slip and pay receive payment and issue Laboratory Tests
applicable fees official receipt Price List

(6am to 11:30am- Payment

Window, 2nd floor Medical
Arts Building Annex)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
(11:30 onwards-Cashier’s
Office Basement Hospital
Building and OPD Cashier)

Make sure to keep charge

slip and get official receipt

2.1 For HMO card holders,

get charge slip from
Window 10
3. Proceed to Window 11, 3. Enter and stamp requested Official Receipt and 5 minutes Receptionist-on-duty
present charge slip and laboratory tests in the Charge slip
official receipt Laboratory Information
System

3.1 Return charge slip and

OR to patient and issue
number for Blood Extraction

4. Once number is called, 4. Call patient’s number for 15 minutes Medical Technologist-on-
proceed to blood extraction blood extraction duty
room

(Room 12, Mezzanine MAB

Annex)

For non-blood tests, submit 4.1 Receive non-blood Receptionist-on-duty

specimen to Receiving specimen and advice on
Window (Mezzanine MAB releasing of results
Annex)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
Conduct Laboratory Test 2 hours Medical Technologist-on-
procedure duty

6. Claim official result Release official result None 3 minutes Staff-on-duty

Consult your doctor for interpretation of results
Total None 3 hours and 3 minutes
End of Transaction
Maintenance of Wakefulness Test (MWT)
A daytime sleep study that measures your ability to stay awake and alert during the day

Office/Division: Pulmonary Medicine Division/Sleep Studies Unit

Classification: Highly Technical
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Request of procedure - Doctor’s Clinic

( 1 original copy)

If payment is through financial assistance/insurance:

1. Service Issue Slip (SIS)
or - Social Service
2. Health Maintenance Organization (HMO) Letter Of
Authorization (LOA) - HMO Coordinator

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Present request of 1. Receive request. None 10 minutes Sleep Technologist or Sleep

procedure and get a Fellow
schedule of procedure at 1.1 Instruct patient on
the Sleep Studies Unit preparation of procedure Sleep Reception Area
Reception Area
1.2 Schedule and inform
patient to return for the
procedure 30 days after the
day of scheduling
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Fill up forms and 1. Explain procedure, assist in None 11 hours Sleep Technologist
questionnaires, and undergo filling out forms and
procedure at the Sleep Studies questionnaires, and Sleep Studies Unit
Unit facilitate MWT. Procedure Bedroom

2. Get charge slip and notice 2. Issue charge slip, notice of None 5 minutes Sleep Technologist
of discharge at the Sleep discharge. Sleep Studies Unit
Studies Unit

3. Pay applicable fees at 3. Receive payment and issue PHP 9,800

designated Cashier Official Receipt (OR), sign 30 minutes Cashier
notice of discharge Professional fee - Cashier’s Office
PHP 1,000

4. Present Official Receipt and

4. Record official receipt, sign Nurse On Duty
notice of discharge at the None 5 minutes
notice of discharge SSU Nurse Station
Short Stay Unit Nurse Station

5. Claim Official result after 5 5. Release result None 5 days Sleep Technologist or Sleep
working days at the Sleep Fellow
Studies Unit Reception Area
Sleep Studies Unit
Reception Area
Consult your doctor for interpretation of results
Total PHP 10,800 36 days
End of Transaction
* The 8-10 hours recording of the procedure can only be interpreted by two (2) specialized sleep doctors; release of
result are within 5 days after the procedure.
 PHILIPPINE HEART CENTER
RADIOLOGICAL SCIENCES DIVISION

RATES – August 1, 2018

OPD, Emergency Room Semi-Private Rooms Private Rooms/Private

(ER), Service and Pay Including Semi-Private Rooms in SICU/MICU/
PROCEDURE Wards Rooms, SICU/MICU/CCU/ CCU/PICU SUITE ROOMS
PICU/NICU, Isolation Rooms
ULTRASOUND Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL
1. Whole Abdomen – Station 2,840 875 3,715 3,250 1,000 4,250 3,700 1,150 4,850 4,100 1,250 5,350
2. Whole Abdomen – Bedside 3,400 1,050 4,450 3,900 1,200 5,100 4,400 1,350 5,750 4,950 1,500 6,450
3. Whole Abdomen & Adrenal 2,840 875 3,715 3,250 1,000 4,250 3,700 1,150 4,850 4,100 1,250 5,350
4. Upper Abdomen – Station 2,440 750 3,190 2,800 865 3,665 3,150 975 4,125 3,550 1,100 4,650
5. Upper Abdomen – Bedside 2,950 900 3,850 3,400 1,050 4,450 3,850 1,150 5,000 4,300 1,300 5,600
6. Upper Abdomen & Adrenal 2,440 750 3,190 2,800 865 3,665 3,150 975 4,125 3,550 1,100 4,650
7. Hepatobiliary Tree (HBT) – Station 1,645 505 2,150 1,900 580 2,480 2,150 655 2,805 2,400 730 3,130
8. Hepatobiliary Tree (HBT) – Bedside 2,000 600 2,600 2,300 690 2,990 2,600 780 3,380 2,900 870 3,770
9. Kidneys 1,305 400 1,705 1,500 460 1,960 1,700 520 2,220 1,900 580 2,480
10. Gallbladder 900 270 1,170 1,050 310 1,360 1,150 350 1,500 1,300 390 1,690
11. Liver 900 270 1,170 1,050 310 1,360 1,150 350 1,500 1,300 390 1,690
12. Aorta – Station 1,305 435 1,740 1,500 500 2,000 1,700 565 2,265 1,900 630 2,530
13. Aorta – Bedside 1,550 520 2,070 1,800 600 2,400 2,000 675 2,675 2,250 750 3,000
14. Chest – Station 900 270 1,170 1,050 310 1,360 1,150 350 1,500 1,300 390 1,690
15. Chest – Bedside 1,100 300 1,400 1,250 350 1,600 1,450 390 1,840 1,600 435 2,035
16. Appendix 900 270 1,170 1,050 310 1,360 1,150 350 1,500 1,300 390 1,690
17. RT Lower Quadrant 900 270 1,170 1,050 310 1,360 1,150 350 1,500 1,300 390 1,690
18. KUB 1,645 505 2,150 1,900 580 2,480 2,150 655 2,805 2,400 730 3,130
19. KUB, Prostate – Station 1,645 505 2,150 1,900 580 2,480 2,150 655 2,805 2,400 730 3,130
20. KUB, Prostate – Bedside 2,000 600 2,600 2,300 690 2,990 2,600 780 3,380 2,900 870 3,770
21. KUB, Pelvis – Station 1,645 505 2,150 1,900 580 2,480 2,150 655 2,805 2,400 730 3,130
22. KUB, Pelvis – Bedside 2,000 600 2,600 2,300 690 2,990 2,600 780 3,380 2,900 870 3,770
23. Scrotal 1,020 315 1,335 1,150 360 1,510 1,350 410 1,760 1,500 455 1,955
24. Breast 910 280 1,190 1,050 320 1,370 1,200 365 1,565 1,300 400 1,700
25. Thyroid 900 300 1,200 1,050 350 1,400 1,150 390 1,540 1,300 435 1,735
26. Pelvis 1,250 270 1,520 1,450 310 1,760 1,650 350 2,000 1,800 390 2,190
 PHILIPPINE HEART CENTER
RADIOLOGICAL SCIENCES DIVISION

RATES – August 1, 2018

OPD, Emergency Room Semi-Private Rooms Private Rooms/Private

(ER), Service and Pay Including Semi-Private Rooms in SICU/MICU/
PROCEDURE Wards Rooms, SICU/MICU/CCU/ CCU/PICU SUITE ROOMS
PICU/NICU, Isolation Rooms
ULTRASOUND Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL
27. Fetal Sex 850 245 1,095 1,000 280 1,280 1,100 320 1,420 12,350 355 12,705
28. Fetal Aging 850 245 1,095 1,000 280 1,280 1,100 320 1,420 1,250 355 1,605
29. UB/Prostate 850 245 1,095 1,000 280 1,280 1,100 320 1,420 1,250 355 1,605
30. Transrectal 1,305 400 1,705 1,500 460 1,960 1,700 520 2,220 1,900 580 2,480
31. Transvaginal 1,305 400 1,705 1,500 460 1,960 1,700 520 2,220 1,900 580 2,480
32. Thoracentesis – Station 2,050 2,050 2,350 2,350 2,650 2,650 3,000 3,000
33. Thoracentesis – Bedside 2,450 2,450 2,800 2,800 3,200 3,200 3,550 3,550
34. Pigtail Insertion – Station 1,800 1,800 2,050 2,050 2,350 2,350 2,600 2,600
35. Pigtail Insertion – Bedside 2,150 2,150 2,450 2,450 2,800 2,800 3,100 3,100
36. Paracentesis 2,050 2,050 2,350 2,350 2,650 2,650 3,000 3,000
37. Neonatal Intracranial – Station 1,650 270 1,920 1,900 310 2,210 2,150 350 2,500 2,400 390 2,790
38. Neonatal Intracranial – Bedside 1,250 300 1,550 1,450 350 1,800 1,650 390 2,040 1,800 435 2,235
39. FNAB-Liver 2,050 2,050 2,350 2,350 2,650 2,650 3,000 3,000
40. FNAB-Thyroid 2,050 2,050 2,350 2,350 2,650 2,650 3,000 3,000
41. FNAB-Breast 2,050 2,050 2,350 2,350 2,650 2,650 3,000 3,000
42. Cyst Aspiration 2,050 2,050 2,350 2,350 2,650 2,650 3,000 3,000
43. Portable vein Doppler Study 2,900 700 3,600 3,350 800 4,150 3,750 910 4,660 4,200 1,000 5,200
44. IVC Doppler Study 2,900 700 3,600 3,350 800 4,150 3,750 910 4,660 4,200 1,000 5,200
45. Pelvic with Doppler 1,875 625 2,500 2,150 720 2,870 2,450 815 3,265 2,700 900 3,600
46. Resistivity Indices, Renal 2,000 700 2,700 2,300 805 3,105 2,600 910 3,510 2,900 1,000 3,900
47. Any One Organ – Station 900 270 1,170 1,050 310 1,360 1,150 350 1,500 1,300 390 1,690
48. Any One Organ – Bedside 1,100 300 1,400 1,250 350 1,600 1,450 390 1,840 1,600 435 2,035
49. Any Two Organ – Station 1,305 435 1,740 1,500 500 2,000 1,700 565 2,265 1,900 630 2,530
50. Any Two Organ – Bedside 1,550 500 2,050 1,800 575 2,375 2,000 650 2,650 2,250 725 2,975
51. Any Three Organ – Station 1,645 505 2,150 1,900 580 2,480 2,150 655 2,805 2,400 730 3,130
52. Any Three Organ – Bedside 2,000 600 2,600 2,300 690 2,990 2,600 780 3,380 2,900 870 3,770
53. Any Four Organ – Station 2,045 630 2,675 2,350 725 3,075 2,650 820 3,470 2,950 910 3,860
 PHILIPPINE HEART CENTER
RADIOLOGICAL SCIENCES DIVISION

RATES – August 1, 2018

OPD, Emergency Room Semi-Private Rooms Private Rooms/Private

(ER), Service and Pay Including Semi-Private Rooms in SICU/MICU/
PROCEDURE Wards Rooms, SICU/MICU/CCU/ CCU/PICU SUITE ROOMS
PICU/NICU, Isolation Rooms
ULTRASOUND Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL
54. Any Four Organ – Bedside 2,400 750 3,150 2,750 865 3,615 3,100 975 4,075 3,500 1,100 4,600
55. Any Five Organ – Station 2,440 750 3,190 2,800 865 3,665 3,150 975 4,125 3,550 1,100 4,650
56. Any Five Organ – Bedside 2,950 900 3,850 3,400 1,050 4,450 3,850 1,150 5,000 4,300 1,300 5,600
57. Elastography 700 250 950 800 290 1,090 910 325 1,235 1,000 365 1,365
MAMMOGRAM**
1 Mammography Bilateral CC + MLO 1,200 440 1,640 1,400 500 1,900 1,550 570 2,120 1,750 640 2,390
Mammography Unilaterial CC MLO
2 ML Axillary Trail 1,200 440 1,640 1,400 500 1,900 1,550 570 2,120 1,750 640 2,390
3 Cleavage View 300 110 410 350 125 475 400 145 545 450 160 610
4 Magnification View (CC or MLO) 300 110 410 350 125 475 400 145 545 450 160 610
5 Exaggerated Views CC 300 110 410 350 125 475 400 145 545 450 160 610
6 Rolled View (CC or MLO View) 300 110 410 350 125 475 400 145 545 450 160 610
7 Targeted Ultrasound 300 110 410 350 125 475 400 145 545 450 160 610
8 Breast Ultrasound 910 280 1,190 1,050 320 1,370 1,200 365 1,565 1,300 400 1,700
Mammogram with Breast Ultrasound
9 package 1,900 650 2,550 2,200 750 2,950 2,450 850 3,300 2,750 950 3,700
10 Mammo-guided Biopsy* 1,800 1,800 2,070 2,070 2,350 2,350 2,600 2,600
11 Ultrasound guided Biopsy* 1,800 1,800 2,070 2,070 2,350 2,350 2,600 2,600

* Professional Fee – will be charged separately

** Effective April 22, 2019
Mammography Procedure
X-ray of the breast.
A screening tool used to detect and diagnose breast pathology.

Office/Division: Mammogram Section

Classification: Complex
Type of G2C - Government to Citizen
Transaction:
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request of procedure - Doctor’s Clinic
(1 original copy)

2. Patient’s identification card - Patient

If payment is through financial
assistance/insurance:
1. Guarantee Letter - DOH, PCSO
2. Health Maintenance Organization (HMO) - HMO Coordinator
Letter of Authorization (LOA) with valid
date
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Present 1. Receive None 2 minutes Clerk/Radiologic

requirements requirements and issue Technologist
at Ultrasound Patient Data Form.
Reception Ultrasound Reception Area
Area (Hospital
Bldg, Ground
Floor)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

2. Fill out Patient 2. Receive None 5 minutes Clerk/Radiologic

Data Form at signed Technologist
Ultrasound Patient
Reception Data Form
Area 2.1 Encode/ Ultrasound Reception Area
register
patient
data
2.2 Issue
charge slip

3. Proceed and 3. Receive P 1,1640.00 30mins. Cashier 1/Cashier2

pay applicable payment
fees at the and issue
Cashier’s Official
Office (MAB Receipt
Basement/ (OR)
Hospital Lobby
Ground Floor) Cashier’s Office (MAB
and secure an Basement/ Hospital Lobby
Official Ground Floor)
Receipt

4. Present 4. Record the None 5 minutes Clerk/Radiologic

Official official Technologist
Receipt at receipt
Ultrasound number Ultrasound Reception Area
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
Reception Area. 4.1 Resident Resident Mammography
Mammography rotator Rotator at the Ultrasound
will interview the patient Section

5. Proceed and 5. Perform None 20 minutes Radiologic Technologist,

cooperate in the requested procedure *Ambulatory (5- Doctor
procedure. and instruct patient 10mins.)
to comeback and Mammography Examination
claim the result. *Wheelchair Borne Room
(15-20mins.)

6. Return and 6. Release

present official official Clerk/Radiologic
Identification Card result; Technologist
to claim the result person to
at the Radiology claim the None Radiology
Reception Area official result Reception Area
and present the must be (Releasing Window)
result to the asked to 3 working days
Attending/ sign at the
Referring Radiology
Physician. Result
Logbook
Note: Present
authorization
letter if the patient
is not available.
Consult your doctor for interpretation of results
Total P 1,640.00 3 working days.
End of Transaction
Medical Consultation from a Physiatrist
The medical consultation consists of a comprehensive rehabilitation program based on objective assessment by the rehabilitation medicine specialist
who dictates the treatment to be carried out by the rehabilitation therapists (Physical Therapy, Occupational Therapy, Speech Therapy, Splint
Fabrication and the need for Diagnostic Procedures)

Office/Division: Physical Medicine and Rehabilitation Division

Classification: Simple
Type of Transaction: G2C: Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Referral Letter (if available) - Referring Physician / Doctor’s Clinic

( 1 original copy)

If payment is through financial assistance/insurance/inter-

agency
1. Social Service Issue Slip - PHC Social Service Division
2. Health Maintenance Organization (HMO) Letter Of - HMO Coordinator
Authorization (LOA)

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present referral letter if 1. Register patient
available at the PMRD 1.1. Receive referral letter (if None 5 minutes Rehab Receptionist
reception area (8th fl, available)
MAB) or inform the 1.2. Ask patient to fill-out
receptionist for necessary details on the Reception Area, PMRD
rehabilitation medicine Outpatient Consultation
consult Sheet
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Wait for name to be 2. Instruct patient to wait for None 1 hour Rehab Receptionist
called at the PMRD name to be called by the
reception area (8th fl, physiatrist Reception Area, PMRD
MAB)
3. Submit self for consult 3. Perform Rehabilitation consult
and evaluation at the 3.1. Prescribe necessary None 20 minutes
consultation room medications / laboratories Physiatrist / Rehab Doctor
(if applicable)
3.2. Design appropriate
rehabilitation program Consultation Room, PMRD
4. Pay applicable fees 4. Receive payment and issue Varies depending on Rehab Receptionist
Official Receipt and facilitate in Rehab Doctor 3 minutes
availing rehabilitation services Reception Area, PMRD

Total 1 hour and 28 minutes

End of Transaction
 Mobile Blood Donation Activity
Blood Collection outside the Institution which requires coordinated agreement between the Institution and Partner Agency/Organization.

Office/Division: Blood Bank

Classification: Complex
Type of Transaction: G2C
G2B
G2G
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Approved/ signed Memorandum of Agreement (MOA) - Blood Bank (previously signed/approved MOA by both partners
(1 original copy)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Request for Mobile 1. Check availability of None * 1 month Mobile Blood Donation
Blood Donation requested schedule (MBD) Team Leader or
Activity and wait for 1.1 Call partner agency for Nurse
confirmation of the confirmation and
MBD Activity availability of schedule

(Blood Bank 1.2 Recheck final

Reception Area, MAB confirmation for the said 1 week
Annex Building activity
Mezzanine, 2nd Floor
Window 14)
(8)929-16-38

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Check venue and 2. Prepare Registration, None 30 minutes Medical Technologist or
physical set-up. Screening/ Interview (pre Blood Bank Nurse
(Organizer) counselling), bleeding,
(Mobile Blood processing, refreshment
Donation Activity and Holding Area
venue)
3. Read educational 3. Conduct brief None 10 minutes Medical Technologist or
material about blood orientation about blood Blood Bank Nurse
donation, listen to donation procedure and
orientation and
pre- donation counselling
cooperate with pre-
donation counselling
(Mobile Blood
Donation Activity
venue)

4. Fill-out and submit 4. Receive and check None 15 minutes Medical Technologist or
Donor's History Donor's History Blood Bank Nurse
Questionnaire Questionnaire
(Mobile Blood
Donation Activity
venue)

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
5. Wait for name to be 5. Assess, Interview and None 15 minutes Medical Technologist ,
called for interview, check vital signs and Pathology Residents or
checking of vital signs hemoglobin result Blood Bank Nurse
and hemoglobin testing

(Mobile Blood
Donation Activity
venue)

6. If qualified, collect 6. Prepare blood bags for None 15 minutes Medical Technologist or
and submit urine blood donation and label Blood Bank Nurse
sample (60ml) and fill properly with donor's
up Custody and Control initials and MBD donor's
Form (CCF) for drug assigned numbers
testing
6.1 Receive and check
(Mobile Blood urine sample
Donation Activity
venue)
7. Proceed to bleeding 7. Properly identify client None 30 minutes Medical Technologist or
area for blood collection for blood donation Blood Bank Nurse
of (450cc), rest for 10-
15 minutes and take 7.1 Ask for name and date
refreshments after of birth
blood collection of 7.2 Prepare donor for
(450cc) Blood donation
 Total None 1 month and 1 week for
scheduling/ confirmation
of MBD Activity .

Mobile Blood Donation

process :

2 hours

End of Transaction

*Mobile Blood Donation processing time of 1 month is indicated on the guidelines in Memorandum
of Agreement of Partner Agency.
Multiple Sleep Latency Test (MSLT)
A Sleep disorder diagnostic tool that measures excessive daytime sleepiness and narcolepsy

Office/Division: Pulmonary Medicine Division/Sleep Studies Unit

Classification: Highly Technical
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Request of procedure - Doctor’s Clinic

( 1 original copy)

If payment is through financial assistance/insurance:

1. Service Issue Slip (SIS) - Social Service
or
2. Health Maintenance Organization (HMO) Letter Of - HMO Coordinator
Authorization (LOA)

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Present request of 1. Receive request. None 10 minutes Sleep Technologist or Sleep

procedure and get a 1.1 Instruct patient on Fellow
schedule of procedure preparation of procedure
at the Sleep Studies 1.2 Schedule and inform Sleep Studies Unit
Reception Area
Unit Reception Area patient to return for the
procedure after 30 days from
the day of scheduling

*Unit can only accommodate 2

patients per day
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

2. Fill-out forms and 2. Explain procedure, assist in None 11 hours Sleep Technologist
questionnaires, and filling out forms and
undergo procedure at questionnaires, and Sleep Studies Unit
the Sleep Studies Unit facilitate MSLT. Procedure Bedroom

3. Get charge slip and 3. Issue charge slip, notice of None 5 minutes Sleep Technologist
notice of discharge at discharge. Sleep Studies Unit
the Sleep Studies Unit

4. Pay applicable fees at 4. Receive payment and issue PHP 9,800 30 minutes
designated Cashier Official Receipt (OR), sign Professional fee - Cashier
notice of discharge PHP 1,000 Cashier’s Office

5. Present Official Receipt 5. Record official receipt, sign None 5 minutes Nurse On Duty
and notice of discharge at notice of discharge Short Stay Unit
the Short Stay Unit Nurse
Station

6. Claim official result after 5 6. Release result None 5 days Sleep Technologist or Sleep
working days at the Sleep Fellow
Studies Unit Reception Area
Sleep Studies Unit
Reception Area
Consult your doctor for interpretation of results
Total PHP 10,800 35 days 11 hrs 50 mins
End of Transaction
* The 8-10 hours recording of the procedure can only be interpreted by two (2) specialized sleep doctors; release of
result are within 5 days after the procedure.
Neonates and Pediatric Pulmonary Function Test
A breathing test for infants and children to determine diseases like bronchial asthma and other conditions that affect breathing.

Office/Division: PULMONARY MEDICINE DIVISION/PULMONARY LABORATORY

Classification: SIMPLE

Type of Transaction G2C

Who may avail: New born to 18 years old

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Doctor's request Attending Physician – Clinic Room
For service patients
 Service OPD card Social Service Division – Annex Bldg.
If payment is through financial assistance/HMO
1. Service Issue Slip (SIS) Social Service Division – Annex Bldg.
2. Health Maintenance Organization (HMO) Letter of HMO Coordinator
Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
1. Present requirements, fill out 1. Receive requirements None 15 Minutes Clerk III
patient data slip and sign Fall Risk Pulmonary Laboratory
Prevention Consent at Pulmonary 1.1 Check doctors request Reception Area
Laboratory reception, Ground 1.2 Issue patient data slip
Floor, Hospital Bldg. 1.3 Interview the client
and give Fall Risk
Prevention Consent
1.4 Instruct patient to wait
for name to be called.
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
2. Cooperate during performance 2. Get patient height and None 1. For Tidal Breathing Respiratory Therapist
of the procedure at the Pulmonary weight Analysis – 2 Hours Pulmonary Laboratory PFT
Laboratory PFT area. 2. For Pedia Area
2.1 Explain the test. Spirometry – 1 Hour
2.2 Assist patient in the 45 Minutes
performance of procedure.
3. Receive charge slip and pay 3. Issue charge slip *Please see table 35 Minutes Clerk III
applicable fees at designated of fees below Pulmonary Laboratory
Cashier area. 3.1 Instruct client to pay Reception area
*Hospital Lobby, near stairway, applicable fees and to
Monday to Fridays 8 am - 9 pm return to Pulmonary
* Basement Cashier – Monday to Laboratory reception after
Sunday 8 am – 7:30 pm payment

3.1 Secure official receipt

4. Present official receipt at 4. Receive official receipt None 5 Minutes Clerk III
Pulmonary Laboratory reception 4.1 Release initial copy of Pulmonary Laboratory
area the test Reception area
4.2 Instruct relative to
claim result after 3 days.
5. Present official receipt and claim Release result None 3 Days Clerk III
result at Pulmonary Laboratory Pulmonary Laboratory
reception area on appointed time. Reception area
*Please see table 1. For Tidal Breathing
of fees below Analysis – 3 Days 2
Hours 55 Minutes
Total 2. For Peda
Spirometry – 3 Days 2
Hours 40 Minutes
End of Transaction
 PROCEDURE PROCEDURE'S FEE READER'S FEE TOTAL

Tidal Breathing Analysis P 2,075.00 P 180.00 P 2,255.00

Spirometry Pedia P 2,280.00 P 180.00 P 2,460.00

Non-Invasive Ambulatory Diagnostic Procedures

24hour HOLTER MONITORING (HM) - a procedure that records the 24 hour ECG using a monitor attached to the patient.
24hour AMBULATORY BP MONITORING (ABP) - a procedure that records BP and heart rate for 24 hours using a BP apparatus
attached to the upper arm

DIVISION : Non-Invasive Cardiology

CLASSIFICATION : Complex
TYPE OF TRANSACTION : G2C
WHO MAY AVAIL : All (Service patients need to be admitted)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor's request for procedure - Doctor's clinic
2. Valid Identification card (two,original)
(Company ID, Passport, Sen. Citizen ID, GSIS/SSS, postal ID
3. If applicable:
a. Letter of Authorization (LOA) - HMO Coordinator
b. Approved Guarantee Letter - Social Service Division (PHC annex)
c. OPD Card - Social Service of origin (hospital)
d. Approved Inter-agency referral letter (HHC) - Out-Patient Division (PHC annex)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Present the requirements 1. Receive requirements None 25 minutes Clerk on Duty
to the NICD Window 1 or 2 1.1 Issue out-patient form
MAB, Ground floor 1.2 Assign number for queuing

2. Fill out Out-patient data form 2. Process registration None 10 minutes Clerk on Duty
2.1 Give charge slip
2.2 Instruct patient to pay
applicable fees

3. Pay applicable fees 3.Receive applicable fees and HM: 4100 pHp 30 minutes Cashier
issue OR ABP: 3725 pHp
 cashier's office:
basement(MAB)
annex building
lobby,hospital bldg

Make sure to get

official receipt (OR)

4. Sign consent and instruction 4. Get signed forms and attach None 30 minutes Medical Technologist
form and cooperate during the unit.
attachment of the unit 4.1 Orient and instruct to record
events in the diary and come back
after 24 hrs.

5. Return on appointed 5. Receive diary and give to None 10 minutes Clerk on duty
date and present diary HM tech

6. Cooperate during 6. Detach the unit and check None 15 minutes Medical Technologist
detachment of the unit recorded data
6.1 Return IDs and instruct when
to claim the result

*Process Result
7. Claim the result 7 days
Consult your doctor for interpretation of results
TOTAL None 7 days and 2 hours
End of Transaction
Non-Invasive Diagnostic Procedures
ELECTROCARDIOGRAM (12L/15L ECG) - a graphic recording of the electrical potentials in association with the heartbeat (20 minutes)
TREADMILL STRESS TEST (TET) - a medical procedure that requires the patient to walk on a treadmill and screen for Coronary Artery disease
2D ECHO DOPPLER (2DED) - a diagnostic procedure that utilizes ultrasound to see the presence or absence of structural abnormalities of the
heart
TREADMILL STRESS ECHO (TSE) - a test that combines stress ECG and echo to detect Coronary Artery Disease
DOBUTAMINE STRESS ECHO (DSE) - a test that combines stress ECG and echo with Dobutamine to further diagnose Coronary Artery Disease or
determine cardiac reserve
3D TRANSESOPHAGEAL ECHO (3D TEE) - a specialized type of echo that uses a transducer positioned in the esophagus to provide better imaging of the heart.

DIVISION : Non-Invasive Cardiology Division (NICD)

CLASSIFICATION : ECG, TET, 2DED (Simple) TSE, DSE and TEE (Complex)
TYPE OF TRANSACTION : G2C
WHO MAY AVAIL : All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor's request for procedure - Doctor's clinic
2. If applicable:
a. Letter of Authorization (LOA) - HMO Coordinator
b. Approved Guarantee Letter - Social Service Division (PHC annex)
c. OPD Card - Out-Patient Division (PHC annex)
d. Approved Inter-agency referral letter (HHC) - Social Service of origin (hospital)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present the requirement/s 1. Receive requirements None 15 minutes Clerk on Duty
to the NICD Window 1 or 2 1.1 Issue out-patient
MAB Ground floor form
1.2 Assign number
for queueing.
2. Fill out Out-patient data form 2. Process registration None 10 minutes Clerk on Duty
and sign Fall Consent form 2.1 Give charge slip
for diagnostic tests 2.2 Instruct patient to
except ECG pay applicable fees
 PHILIPPINE HEART CENTER
NUCLEAR DIVISION

RATES-August 1, 2018

OPD, Emergency Room (ER) Semi-Private Rooms Private Rooms

Service and Pay Wards Including Semi-Private Including Private Rooms in SICU/MICU/ SUITE ROOMS
PROCEDURE Rooms, SICU/MICU/CCU/ CCU/PICU
PICU/NICU, Isolation Rooms
RADIOPHARM. SCAN PROCEDURE PF TOTAL RADIOPHARM. SCAN PROCEDURE PF TOTAL RADIOPHARM. SCAN PROCEDURE PF TOTAL RADIOPHARM. SCAN PROCEDURE PF TOTAL
COST COST TOTAL COST COST COST COST TOTAL COST COST COST COST TOTAL COST COST COST COST TOTAL COST COST
1. Bone Scan Total Body 1,401.40 5,498.60 6,900.00 900.00 7,800.00 1,519.00 6,431.00 7,950.00 1,050.00 9,000.00 1,617.00 7,333.00 8,950.00 1,150.00 10,100.00 1,715.00 8,285.00 10,000.00 1,300.00 11,300.00
2. Bone Scan Three Phase 1,401.40 6,498.60 7,900.00 1,000.00 8,900.00 1,519.00 7,581.00 9,100.00 1,150.00 10,250.00 1,617.00 8,633.00 10,250.00 1,300.00 11,550.00 1,715.00 9,735.00 11,450.00 1,450.00 12,900.00
3. Brain Perfusion Scan (HMPAO) 15,444.00 2,056.00 17,500.00 2,500.00 20,000.00 16,740.00 3,410.00 20,150.00 2,900.00 23,050.00 17,820.00 4,930.00 22,750.00 3,250.00 26,000.00 18,900.00 6,500.00 25,400.00 3,650.00 29,050.00
4. Dacryoscintigraphy 350.35 3,149.65 3,500.00 500.00 4,000.00 379.75 3,670.25 4,050.00 575.00 4,625.00 404.25 4,145.75 4,550.00 650.00 5,200.00 428.75 4,671.25 5,100.00 725.00 5,825.00
5. First Pass RNA 350.35 5,649.65 6,000.00 1,000.00 7,000.00 379.75 6,520.25 6,900.00 1,150.00 8,050.00 404.25 7,395.75 7,800.00 1,300.00 9,100.00 428.75 8,271.25 8,700.00 1,450.00 10,150.00
6. Gastric Emptying Scan 5,000.00 2,000.00 7,000.00 1,000.00 8,000.00 5,750.00 2,300.00 8,050.00 1,150.00 9,200.00 6,500.00 2,600.00 9,100.00 1,300.00 10,400.00 7,250.00 2,900.00 10,150.00 1,450.00 11,600.00
7. Gastroesophageal Reflux San 5,000.00 2,000.00 7,000.00 1,000.00 8,000.00 5,750.00 2,300.00 8,050.00 1,150.00 9,200.00 6,500.00 2,600.00 9,100.00 1,300.00 10,400.00 7,250.00 2,900.00 10,150.00 1,450.00 11,600.00
8. Gated Cardiac Blood Pool 2,717.00 7,283.00 10,000.00 1,500.00 11,500.00 2,945.00 8,555.00 11,500.00 1,750.00 13,250.00 3,135.00 9,865.00 13,000.00 1,950.00 14,950.00 3,325.00 11,175.00 14,500.00 2,200.00 16,700.00
9. Hepatobiliary Scan 2,145.00 7,855.00 10,000.00 1,500.00 11,500.00 2,325.00 9,175.00 11,500.00 1,750.00 13,250.00 2,475.00 10,525.00 13,000.00 1,950.00 14,950.00 2,625.00 11,875.00 14,500.00 2,200.00 16,700.00
10. Infarct Avid Scan 2,717.00 3,283.00 6,000.00 900.00 6,900.00 2,945.00 3,955.00 6,900.00 1,050.00 7,950.00 3,135.00 4,665.00 7,800.00 1,150.00 8,950.00 3,325.00 5,375.00 8,700.00 1,300.00 10,000.00
11. Leg Venography & Lung Perfusion Scan 1,401.40 10,598.60 12,000.00 1,800.00 13,800.00 1,519.00 12,281.00 13,800.00 2,050.00 15,850.00 1,617.00 13,983.00 15,600.00 2,350.00 17,950.00 1,715.00 15,685.00 17,400.00 2,600.00 20,000.00
12. Liver/Spleen Scan (Sulfur Colloid) 7,150.00 1,850.00 9,000.00 1,400.00 10,400.00 7,750.00 2,600.00 10,350.00 1,600.00 11,950.00 8,250.00 3,450.00 11,700.00 1,800.00 13,500.00 8,750.00 4,300.00 13,050.00 2,050.00 15,100.00
13. Lung Perfusion Scan 1,401.40 6,598.60 8,000.00 1,200.00 9,200.00 1,519.00 7,681.00 9,200.00 1,400.00 10,600.00 1,617.00 8,783.00 10,400.00 1,550.00 11,950.00 1,715.00 9,885.00 11,600.00 1,750.00 13,350.00
14. Lung Ventilation Scan 3,975.40 5,524.60 9,500.00 1,300.00 10,800.00 4,309.00 6,641.00 10,950.00 1,500.00 12,450.00 4,587.00 7,763.00 12,350.00 1,700.00 14,050.00 4,865.00 8,935.00 13,800.00 1,900.00 15,700.00
15. Lung Ventilation/Perfusion (V/Q) Scan 5,376.80 11,623.20 17,000.00 2,200.00 19,200.00 5,828.00 13,722.00 19,550.00 2,550.00 22,100.00 6,204.00 15,896.00 22,100.00 2,850.00 24,950.00 6,580.00 18,070.00 24,650.00 3,200.00 27,850.00
16. Lymphoscintigraphy 7,150.00 3,850.00 11,000.00 1,500.00 12,500.00 7,750.00 4,900.00 12,650.00 1,750.00 14,400.00 8,250.00 6,050.00 14,300.00 1,950.00 16,250.00 8,750.00 7,200.00 15,950.00 2,200.00 18,150.00
17. Meckel's Diverticulum Scan 1,859.00 5,141.00 7,000.00 1,000.00 8,000.00 2,015.00 6,035.00 8,050.00 1,150.00 9,200.00 2,145.00 6,955.00 9,100.00 1,300.00 10,400.00 2,275.00 7,875.00 10,150.00 1,450.00 11,600.00
18. MPS Adenosine Sestamibi 5,662.80 14,337.20 20,000.00 3,000.00 23,000.00 6,138.00 16,862.00 23,000.00 3,450.00 26,450.00 6,534.00 19,466.00 26,000.00 3,900.00 29,900.00 6,930.00 22,070.00 29,000.00 4,350.00 33,350.00
19. MPS Adenosine Thallium 7,807.80 14,192.20 22,000.00 3,300.00 25,300.00 8,463.00 16,837.00 25,300.00 3,800.00 29,100.00 9,009.00 19,591.00 28,600.00 4,300.00 32,900.00 9,555.00 22,345.00 31,900.00 4,800.00 36,700.00
20. MPS Dypiridamole Sestamibi 5,662.80 11,937.20 17,600.00 2,400.00 20,000.00 6,138.00 14,112.00 20,250.00 2,750.00 23,000.00 6,534.00 16,366.00 22,900.00 3,100.00 26,000.00 6,930.00 18,570.00 25,500.00 3,500.00 29,000.00
21. MPS Dypiridamole Thallium 7,807.80 12,192.20 20,000.00 3,000.00 23,000.00 8,463.00 14,537.00 23,000.00 3,450.00 26,450.00 9,009.00 16,991.00 26,000.00 3,900.00 29,900.00 9,555.00 19,445.00 29,000.00 4,350.00 33,350.00
22. MPS Exercise Only Sestamibi 2,831.40 6,168.60 9,000.00 1,300.00 10,300.00 3,069.00 7,281.00 10,350.00 1,500.00 11,850.00 3,267.00 8,433.00 11,700.00 1,700.00 13,400.00 3,465.00 9,585.00 13,050.00 1,900.00 14,950.00
23. MPS Exercise Rest Sestamibi 5,662.80 11,937.20 17,600.00 2,400.00 20,000.00 6,138.00 14,112.00 20,250.00 2,750.00 23,000.00 6,534.00 16,366.00 22,900.00 3,100.00 26,000.00 6,930.00 18,570.00 25,500.00 3,500.00 29,000.00
24. MPS Exercise Rest Thallium 7,807.80 12,192.20 20,000.00 3,000.00 23,000.00 8,463.00 14,537.00 23,000.00 3,450.00 26,450.00 9,009.00 16,991.00 26,000.00 3,900.00 29,900.00 9,555.00 19,445.00 29,000.00 4,350.00 33,350.00
25. MPS Rest Redistribution Thallium 7,807.80 9,792.20 17,600.00 2,400.00 20,000.00 8,463.00 11,787.00 20,250.00 2,750.00 23,000.00 9,009.00 13,891.00 22,900.00 3,100.00 26,000.00 9,555.00 15,945.00 25,500.00 3,500.00 29,000.00
26. MPS Resting Sestamibi 2,831.40 5,168.60 8,000.00 1,200.00 9,200.00 3,069.00 6,131.00 9,200.00 1,400.00 10,600.00 3,267.00 7,133.00 10,400.00 1,550.00 11,950.00 3,465.00 8,135.00 11,600.00 1,750.00 13,350.00
27. Parathyroid (Dual tracer subtraction) 3,181.75 6,818.25 10,000.00 1,500.00 11,500.00 3,448.75 8,051.25 11,500.00 1,750.00 13,250.00 3,671.25 9,328.75 13,000.00 1,950.00 14,950.00 3,893.75 10,606.25 14,500.00 2,200.00 16,700.00
28. Renal Cortical Scan 1,401.40 3,798.60 5,200.00 750.00 5,950.00 1,519.00 4,481.00 6,000.00 865.00 6,865.00 1,617.00 5,133.00 6,750.00 1,000.00 7,750.00 1,715.00 5,835.00 7,550.00 1,100.00 8,650.00
29. Renal Diuretic Scan (MAG3) 2,831.40 10,168.60 13,000.00 1,700.00 14,700.00 3,069.00 11,881.00 14,950.00 1,950.00 16,900.00 3,267.00 13,633.00 16,900.00 2,200.00 19,100.00 3,465.00 15,385.00 18,850.00 2,450.00 21,300.00
30. Renal Dynamic Scan with GFR 1,401.40 4,598.60 6,000.00 900.00 6,900.00 1,519.00 5,381.00 6,900.00 1,050.00 7,950.00 1,617.00 6,183.00 7,800.00 1,150.00 8,950.00 1,715.00 6,985.00 8,700.00 1,300.00 10,000.00
31. Renal Dynamic Scan (MAG3) 2,831.40 6,168.60 9,000.00 1,400.00 10,400.00 3,069.00 7,281.00 10,350.00 1,600.00 11,950.00 3,267.00 8,433.00 11,700.00 1,800.00 13,500.00 3,465.00 9,585.00 13,050.00 2,050.00 15,100.00
32. Renal Diuretic Scan (DTPA) 1,401.40 8,598.60 10,000.00 1,500.00 11,500.00 1,519.00 9,981.00 11,500.00 1,750.00 13,250.00 1,617.00 11,383.00 13,000.00 1,950.00 14,950.00 1,715.00 12,785.00 14,500.00 2,200.00 16,700.00
33. Sialoscintigraphy 1,401.40 3,098.60 4,500.00 700.00 5,200.00 1,519.00 3,681.00 5,200.00 800.00 6,000.00 1,617.00 4,233.00 5,850.00 900.00 6,750.00 1,715.00 4,835.00 6,550.00 1,000.00 7,550.00
Scintimammography & Bone Scan (HDP or
34. MDP) 1,401.40 8,598.60 10,000.00 1,500.00 11,500.00 1,519.00 9,981.00 11,500.00 1,750.00 13,250.00 1,617.00 11,383.00 13,000.00 1,950.00 14,950.00 1,715.00 12,785.00 14,500.00 2,200.00 16,700.00
35. Scintimammography (Sestamibi) 2,831.40 4,668.60 7,500.00 1,000.00 8,500.00 3,069.00 5,581.00 8,650.00 1,150.00 9,800.00 3,267.00 6,483.00 9,750.00 1,300.00 11,050.00 3,465.00 7,435.00 10,900.00 1,450.00 12,350.00
36. Tagged RBC Scan for GI Bleeding 2,645.50 15,354.50 18,000.00 2,700.00 20,700.00 2,867.50 17,832.50 20,700.00 3,100.00 23,800.00 3,052.50 20,347.50 23,400.00 3,500.00 26,900.00 3,237.50 22,862.50 26,100.00 3,900.00 30,000.00
37. Testicular Scan 350.35 5,649.65 6,000.00 900.00 6,900.00 379.75 6,520.25 6,900.00 1,050.00 7,950.00 404.25 7,395.75 7,800.00 1,150.00 8,950.00 428.75 8,271.25 8,700.00 1,300.00 10,000.00
 PHILIPPINE HEART CENTER
NUCLEAR DIVISION

RATES-August 1, 2018

OPD, Emergency Room (ER) Semi-Private Rooms Private Rooms

Service and Pay Wards Including Semi-Private Including Private Rooms in SICU/MICU/ SUITE ROOMS
PROCEDURE Rooms, SICU/MICU/CCU/ CCU/PICU
PICU/NICU, Isolation Rooms
RADIOPHARM. SCAN PROCEDURE PF TOTAL RADIOPHARM. SCAN PROCEDURE PF TOTAL RADIOPHARM. SCAN PROCEDURE PF TOTAL RADIOPHARM. SCAN PROCEDURE PF TOTAL
COST COST TOTAL COST COST COST COST TOTAL COST COST COST COST TOTAL COST COST COST COST TOTAL COST COST

38. Thyroid Scan (Tc99m Pertechnetate) 350.35 1,599.65 1,950.00 300.00 2,250.00 379.75 1,870.25 2,250.00 350.00 2,600.00 404.25 2,145.75 2,550.00 400.00 2,950.00 428.75 2,421.25 2,850.00 435.00 3,285.00
39. Thyroid Uptake & Scan using 1-131 1,287.00 913.00 2,200.00 350.00 2,550.00 1,395.00 1,155.00 2,550.00 400.00 2,950.00 1,485.00 1,365.00 2,850.00 450.00 3,300.00 1,575.00 1,625.00 3,200.00 510.00 3,710.00
Thyroid Uptake & Scan using 1-131 &
40. Tc99m Pertechnetate 1,637.35 2,212.65 3,850.00 350.00 4,200.00 1,774.75 2,675.25 4,450.00 400.00 4,850.00 1,889.25 3,110.75 5,000.00 450.00 5,450.00 2,003.75 3,596.25 5,600.00 510.00 6,110.00
41. Thyroid Radioactive Iodine Uptake 1,287.00 613.00 1,900.00 250.00 2,150.00 1,395.00 805.00 2,200.00 290.00 2,490.00 1,485.00 965.00 2,450.00 325.00 2,775.00 1,575.00 1,175.00 2,750.00 365.00 3,115.00
42. Total Body Scan (Post 1-131 Therapy) - 6,000.00 6,000.00 900.00 6,900.00 - 6,900.00 6,900.00 1,050.00 7,950.00 - 7,800.00 1,150.00 8,950.00 - 8,700.00 1,300.00 10,000.00
43. Total Body Scan (2mCi 1-131) 1,358.50 5,641.50 7,000.00 1,000.00 8,000.00 1,472.50 6,577.50 8,050.00 1,150.00 9,200.00 1,567.50 7,532.50 9,100.00 1,300.00 10,400.00 1,662.50 8,487.50 10,150.00 1,450.00 11,600.00
44. Total Body Scan (5mCi 1-131) 1,358.50 5,641.50 7,000.00 1,000.00 8,000.00 1,472.50 6,577.50 8,050.00 1,150.00 9,200.00 1,567.50 7,532.50 9,100.00 1,300.00 10,400.00 1,662.50 8,487.50 10,150.00 1,450.00 11,600.00
45. Extra CD 1,000.00 1,000.00 1,150.00 1,150.00 1,300.00 1,450.00 1,450.00
46. Extra Result Print Out 500.00 500.00 600.00 600.00 650.00 725.00 725.00

BONE DENSITOMETRY PROCEDURES

1. Routine (Lumbar, Spine & Hips) 2,500.00 1,000.00 3,500.00 2,900.00 1,150.00 4,050.00 3,250.00 1,300.00 4,550.00 3,650.00 1,450.00 5,100.00
2. Whole Body DXA Imaging 3,000.00 1,200.00 4,200.00 3,450.00 1,400.00 4,850.00 3,900.00 1,550.00 5,450.00 4,350.00 1,750.00 6,100.00
3. Routine + Forearm 2,800.00 1,100.00 3,900.00 3,200.00 1,250.00 4,450.00 3,650.00 1,450.00 5,100.00 4,050.00 1,600.00 5,650.00

RADIOIMMUNOASSAY TESTS:
1. FT3 RIA 1,300.00 110.00 1,410.00 1,500.00 125.00 1,625.00 1,700.00 145.00 1,845.00 1,900.00 160.00 2,060.00
2. FT4 RIA 1,300.00 110.00 1,410.00 1,500.00 125.00 1,625.00 1,700.00 145.00 1,845.00 1,900.00 160.00 2,060.00
3. TSH IRMA 1,300.00 110.00 1,410.00 1,500.00 125.00 1,625.00 1,700.00 145.00 1,845.00 1,900.00 160.00 2,060.00
4. FT3 RIA & FT4 RIA 2,300.00 210.00 2,510.00 2,650.00 240.00 2,890.00 3,000.00 275.00 3,275.00 3,350.00 305.00 3,655.00
5. FT3 RIA & TSH IRMA 2,300.00 210.00 2,510.00 2,650.00 240.00 2,890.00 3,000.00 275.00 3,275.00 3,350.00 305.00 3,655.00
6. FT4 RIA & TSH IRMA 2,300.00 210.00 2,510.00 2,650.00 240.00 2,890.00 3,000.00 275.00 3,275.00 3,350.00 305.00 3,655.00
7. FT3, FT4 RIA & TSH IRMA 3,300.00 300.00 3,600.00 3,800.00 345.00 4,145.00 4,300.00 390.00 4,690.00 4,800.00 435.00 5,235.00

RADIOIMMUNOASSAY TESTS: (Individual run)

1. FT3 RIA (STAT) 4,400.00 300.00 4,700.00 5,050.00 345.00 5,395.00 5,700.00 390.00 6,090.00 6,400.00 435.00 6,835.00
2. FT4 RIA (STAT) 4,400.00 300.00 4,700.00 5,050.00 345.00 5,395.00 5,700.00 390.00 6,090.00 6,400.00 435.00 6,835.00
3. TSH IRMA (STAT) 4,400.00 300.00 4,700.00 5,050.00 345.00 5,395.00 5,700.00 390.00 6,090.00 6,400.00 435.00 6,835.00
 PHILIPPINE HEART CENTER
NUCLEAR DIVISION

RATES-August 1, 2018

OPD, Emergency Room (ER) Semi-Private Rooms Private Rooms

Service and Pay Wards Including Semi-Private Including Private Rooms in SICU/MICU/ SUITE ROOMS
PROCEDURE Rooms, SICU/MICU/CCU/ CCU/PICU
PICU/NICU, Isolation Rooms
RADIOPHARM. PROCEDURE PROCEDURE PF TOTAL RADIOPHARM. PROCEDURE PROCEDURE PF TOTAL RADIOPHARM. PROCEDURE PROCEDURE PF TOTAL RADIOPHARM. PROCEDURE PROCEDURE PF TOTAL
COST COST TOTAL COST COST COST COST TOTAL COST COST COST COST TOTAL COST COST COST COST TOTAL COST COST
RADIOPHARMACEUTICAL THERAPY (Private)
1. 5.1 – 8.0 mCi 2,574.00 1,026.00 3,600.00 3,600.00 2,970.00 1,350.00 4,320.00 4,320.00
2. 8.1 – 10.0 mCI 3,503.50 996.50 4,500.00 4,500.00 4,050.00 1,300.00 5,350.00 5,350.00
3. 10.1 – 15.0 mCI 4,680.39 1,319.61 6,000.00 6,000.00 5,400.00 1,700.00 7,100.00 7,100.00
4. 15.1 – 25.0 mCI 6,906.90 593.10 7,500.00 7,500.00 7,970.00 770.00 8,740.00 8,740.00
5. 25.1 – 50.0 mCI 6,935.50 1,364.50 8,300.00 8,300.00 8,000.00 1,750.00 9,750.00 9,750.00
6. 50.1 – 75.0 mCI 8,215.35 3,384.65 11,600.00 11,600.00 9,500.00 4,400.00 13,900.00 13,900.00
7. 75.1 – 100.0 mCI 10,725.00 3,075.00 13,800.00 13,800.00 12,375.00 3,400.00 15,775.00 15,775.00
8. 100.1 – 125.0 mCI 12,062.05 4,437.95 16,500.00 16,500.00 13,900.00 5,750.00 19,650.00 19,650.00
9. 125.1 – 150.0 mCI 13,492.05 3,507.95 17,000.00 17,000.00 15,550.00 4,550.00 20,100.00 20,100.00
10. 150.1 – 175.0 mCI 15,315.30 4,484.70 19,800.00 19,800.00 17,650.00 5,850.00 23,500.00 23,500.00
11. 175.1 – 200.0 mCI 19,505.20 3,594.80 23,100.00 23,100.00 22,500.00 4,650.00 27,150.00 27,150.00
12. >200 mCi 23,566.40 2,833.60 26,400.00 26,400.00 27,200.00 3,700.00 30,900.00 30,900.00

RADIOPHARMACEUTICAL THERAPY (Service)

1. 5.1 – 8.0 mCi 2,574.00 626.00 3,200.00 3,200.00 2,970.00 815.00 3,785.00 3,785.00
2. 8.1 – 10.0 mCI 3,503.50 596.50 4,100.00 4,100.00 4,050.00 775.00 4,825.00 4,825.00
3. 10.1 – 15.0 mCI 4,680.39 819.61 5,500.00 5,500.00 5,400.00 1,050.00 6,450.00 6,450.00
4. 15.1 – 25.0 mCI 4,830.00 2,070.00 6,900.00 6,900.00 7,970.00 2,700.00 10,670.00 10,670.00
5. 25.1 – 50.0 mCI 6,935.50 564.50 7,500.00 7,500.00 8,000.00 735.00 8,735.00 8,735.00
6. 50.1 – 75.0 mCI 8,215.35 2,284.65 10,500.00 10,500.00 9,500.00 2,950.00 12,450.00 12,450.00
7. 75.1 – 100.0 mCI 10,725.00 1,775.00 12,500.00 12,500.00 12,375.00 2,300.00 14,675.00 14,675.00
8. 100.1 – 125.0 mCI 12,062.05 1,937.95 14,000.00 14,000.00 13,900.00 2,500.00 16,400.00 16,400.00
9. 125.1 – 150.0 mCI 13,492.05 2,007.95 15,500.00 15,500.00 15,550.00 2,600.00 18,150.00 18,150.00
10. 150.1 – 175.0 mCI 15,315.30 2,684.70 18,000.00 18,000.00 17,650.00 3,500.00 21,150.00 21,150.00
11. 175.1 – 200.0 mCI 19,505.20 1,494.80 21,000.00 21,000.00 22,500.00 1,950.00 24,450.00 24,450.00
12. >200 mCi 23,566.40 433.60 24,000.00 24,000.00 27,200.00 550.00 27,750.00 27,750.00
Nuclear Medicine Imaging Procedure
Imaging using various radiopharmaceuticals for further assessment of the patient’s medical condition.

Office or Division: Nuclear Medicine Division

Classification: Highly Technical

Type of Transaction: G2C

Who may avail: All

CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s Request Clinic of the referring physician.

2. OPD Card(for PHC service patient) Philippine Heart Center, Out Patient Division.

3. Ancillary and/or laboratory results and Laboratory and/or referring physician

medication prescriptions

4. Official Receipt of payment - Will be provided upon payment at the Treasury office.
(Official receipt from the Treasury office)

5. Other documents which maybe

Accepted as proof of payment. -DOH, PCSO
(HMO, LOA, Service Issue Slip -HMO Coordinator
(Guarantee Letters etc) – (pending approval of the PHC administration)
as long as it is approved by
Philippine Heart Center.)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present imaging 1. Receive and verify None 5 minutes Administrative Assistant or
request at the front desk. imaging request and Nuclear Medical
inform the price and Technologists or
1.1 Fill-out Nuclear earliest available Nuclear Radiological
imaging work-flow sheet. schedule. Technologist

(Nuclear Medicine 1.1 Issue Nuclear

Division, Pagbubungkos imaging work flow
Plaza) sheet.
2. Proceed to the 2. Evaluate patient. None 15 minutes Nuclear Medicine
Interview area. Resident/Fellow
3. Proceed for the 3. Give schedule. None 25 working days Administrative Assistant or
schedule at the Nuclear Nuclear Medical
front desk. 3.1 Instruct the patient Technologists or
to come back on the Nuclear Radiological
given schedule. Technologist

3.2 Give the

request/charge slip on
the day the patient will
pay the
radiopharmaceutical
dose fee.

Note: The gamma

camera machine can
accommodate seven
(7) patients
depending on the
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

procedure daily. At
present only one (1)
machine is working.

4. Pay applicable fees for 4. Receive payment See table of fees 30 minutes Cashier I
the radiopharmaceutical and issue official
cost one day before the receipt.
procedure. Make sure to
get official receipt.

(Treasury office at
basement of the Medical
Arts Building and ground
floor of the Hospital
building)

5. Present the official 5. Record the official None 2 minutes Administrative Assistant or
receipt at the Nuclear receipt number on the Medical Technologists or
Medicine front desk. request slip and log Radiologic Technologist
patient data in the
imaging logbook.

5.1 Confirm schedule.

Note: Payment of the

radiopharmaceutical
will be the basis in
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

ordering the
radiopharmaceutical
dose.

6. Return on scheduled 6. Check and verify None 6 hours and Administrative Assistant or
date for the procedure at requested procedure.
the front desk, present 3 minutes Nuclear Medical
6.1 Official receipt of Technologists or
official receipt
radiopharmaceutical Nuclear Radiologic
radiopharmaceutical cost. Technologist
dose payment

6.2 Return the

(Nuclear Medicine request/issue charge
Division, Pagbubungkos slip for the procedure.
Plaza)
6.3 Administer
radiopharmaceutical
dose and image
patient after a waiting
time.

6.4 Process the

image.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

7. Pay applicable fees for 7. Receive payment See table of fees 30 minutes Cashier I
the procedure at the and issue official
treasury office while receipt.
waiting time for the
imaging. Make sure to get
official receipt.

(Treasury office at
basement Medical Arts
Building and ground floor
of the Hospital building)

8. Present the official 8. Record Official 2 working days Administrative Assistant or

receipt number at the receipt number. Medical Technologists or
Nuclear Medicine front Radiologic Technologist
desk. 8.1 Interpret and
review the process Nuclear Consultant and
images. Resident/Fellow

(Nuclear Medicine 8.2 Instruct patient to

Division, Pagbubungkos come back after 2
Plaza) working days.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

9. Claim result at the 9. Release the official None 10 minutes Administrative Assistant or
Nuclear front desk on the result. Nuclear Medical
schedule date and sign Technologists or
Nuclear Radiologic
on the logbook.
Technologist

(Nuclear Medicine
Division, Pagbubungkos
Plaza)

Consult your doctor for interpretation of results.

TOTAL: See table of fees 27 working days 7 hours &
35 minutes

End of Transaction
 PHILIPPINE HEART CENTER
Wellness Clinic
Out – Patient Diagnostic Packages (Pediatric)
December 03, 2018

SPORTS CLEARANCE

1. Pediatric Sports Package I

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Electrocardiogram 460.00 90.00

Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 1,060.00 225.00 1,150.00

2. Pediatric Sports Package II

Neonates ( 6 years old and below)

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

2-D Echo cardiogram with Doppler 3,580.00 640.00

Treadmill Exercise Test 1,640.00 295.00
Pulmonary Function Test – Neonates 2,075.00 180.00
TOTAL 7,295.00 1,115.00 7,550.00

3. Pediatric Sports Package III

Pediatric ( 7 to 12 years old )

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

2-D Echo cardiogram with Doppler 3,580.00 640.00

Treadmill Exercise Test 1,640.00 295.00
Pulmonary Function Test – Pedia 2,280.00 180.00
TOTAL 7,500.00 1,115.00 7,750.00
 PHILIPPINE HEART CENTER
Wellness Clinic
Out – Patient Diagnostic Packages (Pediatric)
December 03, 2018
4. Pediatric Sports Package IV
Pediatric ( 13 to 18 years old )

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

2-D Echo cardiogram with Doppler 3,580.00 640.00

Treadmill Exercise Test 1,640.00 295.00
Pulmonary Function Test (Pre/Post) 1,290.00 200.00
TOTAL 6,510.00 1,135.00 7,000.00

OUT PATIENT PEDIATRIC DIAGNOSTIC PACKAGES

1. Basic Pediatric Package

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Complete Blood Count 450.00

Routine Urinalysis 235.00
Stool Exam/Fecalysis 135.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 1,420.00 135.00 1,400.00

2. Basic Pediatric Cardio Package

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Electrocardiogram 460.00 90.00

2-D Echo cardiogram with Doppler 3,580.00 640.00
TOTAL 4,040.00 730.00 4,300.00
 PHILIPPINE HEART CENTER
Wellness Clinic
Out – Patient Diagnostic Packages (Pediatric)
December 03, 2018

3. Cardiovascular Risk Assessment

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Complete Blood Count 450.00

Fasting Blood Sugar 285.00
Creatinine 285.00
Total Cholesterol 300.00
HDL 495.00
Triglyceride 355.00
Routine Urinalysis 235.00
Electrocardiogram 460.00 90.00
2-D Echo cardiogram with Doppler 3,580.00 640.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 7,045.00 865.00 7,150.00

4. Cardio-Pulmonary Clearance Package

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Complete Blood Count 450.00

2-D Echo cardiogram with Doppler 3,580.00 640.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 4,630.00 775.00 4,900.00
 PHILIPPINE HEART CENTER
Wellness Clinic
Out – Patient Diagnostic Packages (Pediatric)
December 03, 2018

5. If with cyanosis: Tetralogy of Fallot

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Complete Blood Count 450.00

2-D Echo cardiogram with Doppler 3,580.00 640.00
Chest X-Ray (PA/LAT) 600.00 135.00
Arterial Blood Gas Determination 715.00 85.00
TOTAL 5,345.00 860.00 5,600.00

6. Pre-Operative Assessment

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Complete Blood Count 450.00

Sodium 305.00
Potassium 305.00
Calcium 305.00
BUN 290.00
Creatinine 285.00
Prothrombin Time 450.00
Partial Thromboplastin Time 550.00
Routine Urinalysis 235.00
Blood Typing 350.00
Electrocardiogram 460.00 90.00
2-D Echo cardiogram with Doppler 3,580.00 640.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 8,165.00 865.00 8,150.00
 PHILIPPINE HEART CENTER
Wellness Clinic
Out – Patient Diagnostic Packages (Pediatric)
December 03, 2018

7. Pulmonary Hypertension Package

Neonates ( 6 years old and below)

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Complete Blood Count 450.00

2-D Echo cardiogram with Doppler 3,580.00 640.00
Arterial Blood Gas Determination 715.00 85.00
6 minute Walk Test 500.00
Pulmonary Function Test-Neonate 2,075.00 180.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 7,920.00 1,040.00 8,100.00

8. Pulmonary Hypertension Package

Pediatric ( 7 to 12 years old )

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Complete Blood Count 450.00

2-D Echo cardiogram with Doppler 3,580.00 640.00
Arterial Blood Gas Determination 715.00 85.00
6 minute Walk Test 500.00
Pulmonary Function Test-(Pedia) 2,280.00 180.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 8,125.00 1,040.00 8,250.00
 PHILIPPINE HEART CENTER
Wellness Clinic
Out – Patient Diagnostic Packages (Pediatric)
December 03, 2018

9. Pulmonary Hypertension Package

Pediatric ( 13 to 18 years old )

PROCEDURES HOSPITAL CHARGES READERS' FEES PACKAGE RATE

Complete Blood Count 450.00

2-D Echo cardiogram with Doppler 3,580.00 640.00
Arterial Blood Gas Determination 715.00 85.00
6 minute Walk Test 500.00
Pulmonary Function Test-(Pre/Post) 1,290.00 200.00
Chest X-Ray (PA/LAT) 600.00 135.00
TOTAL 7,135.00 1,060.00 7,400.00
PEDIATRICS CARDIOLOGY (Regular Out-Patient Check-up)
This refers to scheduled follow-up check-up of pediatric patients with cardiovascular diseases. (Maximum of 50 Patients in the morning and another 50 in the afternoon

Office or Division: Out-Patient Division

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: Pedia patients with Cardiac Diseases
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. OPD card 1. OPD Room 2

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Secure a queue number 1. Issue queue number none 5 minutes Clerk
and instruct patient to wait
for number to be flashed/called.
2. Once number is flashed/called 2. Receive queue number, none 15 minutes Clerk
proceed to Room 2, present queue OPD card and register
number and OPD card. 2.1 Issue charge slip

2.1. Wait for initial assessment. 2.1. Take vital signs and Nurse
weight.
3. Pay applicable fees 3. Receive payment P200 = B 20 minutes OPD cashier
OPD Cashier Annex Bldg Issue Official Receipt P150 = C1
P100 = C2
Make sure to get official receipt. P50 = C3
P0 = D
3.1. Present official receipt and return charge 3.1. Receive charge slip, Clerk
slip. check and return official
receipt.
3.2. Wait for the number to be flashed/called 3.2. Instruct patient to wait Clerk
for number to be flashed/called.
4. Once number is called/flashed, proceed to 4. Examine/ assess and none 3 hours Pedia Cardio Fellow
Room 2 for follow-up check-up. analyze laboratory
results. Instruct patient to
proceed to nurse table for
further instructions
5.Receive doctor's order and instructions. 5. Carry out doctor's orders, none 20 minutes Nurse
give instructions and
schedule for the next
follow-up
TOTAL: 4 hours
(for the first 50 patients)
End of Transaction
Polysomnography Procedures (Sleep Studies)
A test used to diagnose and treat sleep-related breathing disorders; and to diagnose a variety of additional sleep disorders.

Office/Division: Pulmonary Medicine Division/Sleep Studies Unit

Classification: Highly Technical
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Request of procedure - Doctor’s Clinic

( 1 original copy)

If payment is through financial assistance/insurance:

1. Service Issue Slip (SIS)
or - Social Service
2. Health Maintenance Organization (HMO) Letter Of
Authorization (LOA) - HMO Coordinator

For Philhealth Claims:

1. Claim Signature Form (CSF) signed by employer and Sleep
Doctor - Sleep Clinic, Employer
2. Member Data Record (MDR)
3. Certificate of Contributions, 9 months continuous - Philhealth kiosk, Philhealth website
contributions prior to schedule (if employed)
4. Receipts of payment, 9 months continuous contributions - Employer
prior to schedule (if voluntary)
- Philhealth Member
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Present request of procedure 1. Receive request. None 10 minutes Sleep Technologist or Sleep
and get a schedule of 1.1 instruct patient on Fellow
procedure at the Sleep preparation of
Studies Unit Reception Area procedure Sleep Studies Unit Reception
1.2 Schedule and inform Area
patient to return for the
procedure after 30 days
from the day of
scheduling.

*Unit can only accommodate 2

patients per day

2. At 8:00 am, Present Doctor’s 2. Receive doctor’s request and None 15 minutes Sleep Technologist and Sleep
request, and Philhealth requirements Fellow
requirements on the day of 2.1 Write down admitting
the schedule at the sleep orders. Sleep Studies Unit Reception
Studies Unit reception area – 2.2 Issue Out on Pass Form Area
for Philhealth Patients
(24 hours admission is a
Philhealth requirement)

At 7:00 pm, proceed to the

Admitting Section - For
outpatients (using financial
assistance/ insurance, or
paying using cash/credit
card)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

3. Register and fill-out 3. Issue out applicable forms None 10 – 30 minutes Admitting clerk
applicable forms at the
Admitting Section 3.1 Assist client in filling out of Admitting Section
Philhealth patients may leave forms
the hospital after this step, and
come back at 7:00 pm.
*Escort patient to the sleep clinic

4. Fill-out forms and 4. Explain procedure, assist in None 12 hours Sleep Technologist
questionnaires, and undergo filling out forms and
procedure at the Sleep questionnaires, and facilitate Sleep Studies Unit Procedure
Studies Unit polysomnography. Bedroom

5. Get charge slip and notice of 5. Issue charge slip, notice of

discharge at the Sleep discharge. None 10 minutes Sleep Technologist
Studies Unit Sleep Studies Unit
5.1 If Philhealth inpatient, issue
Receive Clinical Abstract – Clinical Abstract.
for Philhealth Patients

6. Proceed to the Billing 6. Receive Philhealth For Diagnostic - 1 hour Billing Clerk
Section for discharge requirements, process PHP7,560 Billing Section
process then pay applicable discharge. For Therapeutic -
fees at the PHP11,560
Cashier
designated Cashier at the 6.1 Receive payment and For Split - PHP19,560 30 minutes
Cashier’s Office
Basement, Hospital Building issue Official Receipt (OR), sign
– For Philhealth Patients notice of discharge Professional Fee -
PHP3,240
Pay applicable fees at
designated cashier at the If with capnography:
Ground floor Hospital
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
Building – For Outpatients Pro-Flow adult
cannula - PHP950
Pro-Flow pedia
cannula - PHP1,210
ETCO2 Sampling Line
- PHP1,005

Arterial Blood Gas –

PHP 715
7. Present Official Receipt and 7. Record official receipt, sign None 5 minutes Nurse on duty
notice of discharge at the notice of discharge SSU Nurse Station
Short Stay Unit Nurse
Station
8. Claim official result after 5 8. Release result None 5 days Sleep Technologist or Sleep
working days at the Sleep Fellow
Studies Unit Reception Area
Sleep Studies Unit Reception
Area
Consult your doctor for interpretation of results
Depends on category 35 days 14 hours and
Total
40 minutes
End of Transaction
* The 8-10 hours recording of the procedure can only be interpreted by two (2) specialized sleep doctors; release of
result are within 5 days after the procedure.
Pre-flight Assessment Test/ HAS
A test to simulate cabin altitude to determine if there is a need for oxygen and the amount of oxygen during the entire flight.

Office/Division: Pulmonary Medicine Division/Pulmonary Rehabilitation Unit

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request of Procedure ( original copy) Doctor's clinic

If payment is through financial assistance;

1.Service Issue Slip –Social Service Division

2.Guarantee Letter/Letter of Authorization –HMO Coordinator

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE

PAID TIME
1. Present requirements and get a 1. Receive None 5 minutes RT Coordinator
schedule of procedure at the Requirements CRF
pulmonary rehabilitation reception Pulmonary Rehabilitation Unit
area MAB 8th floor 1.1. Interview the patient Reception area
and Instruct the patient
about the procedure

1.2. Schedule patient if

there's no available slot

2. Fill-out information sheet and 2. Assist client in filling out None 10 minutes RT Coordinator
consent form forms CRF
Pulmonary Rehabilitation
2.1. Get vital signs Unit
Reception area
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
3. Cooperate during performance 3. Assist patient in the None 25 minutes RT Coordinator
of procedure performance of the CRF
procedure Pulmonary Rehabilitation
Unit
HAST room
4. Receive charge slip and pay 4. Issue charge slip Procedure 30 minutes RT Coordinator
applicable fees at Cashier's P3,000.00 Pulmonary Rehabilitation
office ground floor lobby or 4.1. Receive payment and Unit
Basement issue Official Receipt (OR) Professional
Fee Cashier 1 or 2
4.1 Make sure to get OR P500.00 Cashier's office GF
lobby or Basement
+ nasal cannula
and use of
oxygen tank if
needed

5. Present official receipt 5. Record patient data None 2 minutes RT Coordinator

(Reception area Pulmonary and OR receipt CRF
Rehab MAB 8th floor) Pulmonary Rehabilitation
Unit
Reception area

6. Claim result 6. Release of result None 3 minutes CRF

P 3,500.00 1 hour & 15
+ nasal cannula minutes
Total and use of
oxygen tank if
needed
End of Transaction
Use of Oxygen for first 30 minutes

LPM Price

1-2 lpm P 25.00

2-3 lpm P 30.00

3-4 lpm P 35.00

4-6 lpm P 40.00

Use of Medical Supply

Nasal cannula adult P 27.00

Nasal Cannula pedia P 34.00

Psychiatric Consultation
This refers to consultation of service patients and PHC employees to psychiatrist.

Office/Division: Psychiatry and Behavior Medicine Section

Classification: Simple

Type of Transaction G2C Government to Citizen

Who may avail: OPD Service Patients and PHC Personnel

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

OPD Referral Slip for Service Patients Out Patient Division

Infirmary Referral Slip for PHC Employees

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Secure an 1. Log and inform client of None 5 minutes Clerk III
appointment to the schedule or date of
psychiatrist appointment 7th Floor, MAB
Psychiatry and Behavior
Medicine Section
2. Present referral slip 2. Receive referral slip. None 2 hours Clerk III
to clinic on scheduled
date, fill-out forms/ 2.1 Evaluate the patient and Medical Specialist III
questionnaires and give prescription if needed
cooperate during 7th Floor, MAB
consultation Psychiatry and Behavior
Medicine Section
7th Floor, MAB
Psychiatry and Behavior
Medicine Section
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Get follow-up 3. Schedule for follow-up None 5 minutes Clerk III
schedule appointment
4. Return on follow-up 6. Issue Clearance, None 2 hours Medical Specialist III
schedule, receive Certificate or Evaluation
Clearance, Certificate Report after final check-up 7th Floor, MAB
or Evaluation Report Psychiatry and Behavior
once treatment is Medicine Section
completed
Total None 2 hrs per consultation

End of Transaction
Pulmonary Rehabilitation Program
A comprehensive intervention for all chronic lung diseases which includes education, exercise or physical reconditioning and
psychosocial group support in an 8 week session for out-patient setting.

Office/Division: Pulmonary Medicine Division/Pulmonary Rehabilitation Unit

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All patients with Chronic Lung Diseases who can follow instructions
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request of Procedure ( original copy) Doctor's clinic
2. Laboratory and diagnostic tests ( Spirometry, X-ray,
ABG, CBC (1 photocopy each)
If payment is through financial assistance;

1. Service Issue Slip –Social

Service Division
2. Guarantee Letter/Letter of Authorization –HMO Coordinator
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
1. Present 1. Receive None 15 minutes RT Coordinator
requirements requirements CRF
and get a Pulmonary rehabilitation Unit
schedule of 1.1. Interview the Reception area
procedure at the patient and Instruct
pulmonary patient about the
rehabilitation procedure
reception area
MAB 8th floor 1.2. Schedule patient
2. Fill-out 2. Assist client in filling out None 1 hour RT Coordinator
information forms CRF
sheet and Pulmonary rehabilitation Unit
consent form Reception area
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
3. Receive charge slip 3. Issue charge slip Package I 30 minutes RT Coordinator
and pay applicable P 15,500.00 Pulmonary Rehabilitation
fees at Cashier's 3.1. Receive payment and Package II Unit
office ground floor issue Official Receipt (OR) P 20,000.00
lobby or Basement
Cashier 1 or 2
Professional Cashier's office GF
3.1. Make sure to get OR fee lobby or Basement
P 1,000.00
4. Present official receipt 4. Record patient data and None 5 minutes RT Coordinator
OR receipt CRF
Pulmonary rehabilitation Unit
Reception area
5. Cooperate during 5. Assist patient in the None 1 hour & RT Coordinator
performance of performance of the procedure 30 minutes CRF
procedure
Pulmonary rehabilitation
Unit
Reception area
6. Claim result 6. Release of result None 2 days after CRF
completion of 24
sessions
Package I
P 16,500.00
Package II
P 21,000.00
Total
+ nasal
cannula and
use of Oxygen
tank if needed
End of Transaction
Use of Oxygen for first 30 minutes

LPM Price

1-2 lpm P 25.00

2-3 lpm P 30.00

3-4 lpm P 35.00

4-6 lpm P 40.00

Use of Medical Supply

Nasal cannula adult P 27.00

Nasal Cannula pedia P 34.00

Pulmonary/ Thoracic Cardiovascular Surgery Check-up
This refers to follow-up check-up of adult and pediatric patients with cardiovascular diseases referred to Pulmonary/ Thoracic Cardiovascular Surgery Clinic.

Pulmonary (Adult) - Tuesdays and Fridays 1pm Pedia - Wednesday 1pm

Surgery - Mondays and Thursdays 1pm

Office or Division: Out-Patient Division

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: Adult and pediatric patients with Cardiac Diseases referred to Pulmonary/ Thoracic Cardiovascular Surgery Clinic
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. OPD card 1. OPD Room 4

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Secure a queue number on the scheduled 1. Issue queue number and instruct None 5 minutes Clerk
date of check-up patient to wait for number to be flashed/called.

2. Once number is flashed/called proceed to 2. Receive queue number, OPD card, issue None 15 minutes Clerk
Room 4, present queue number and OPD card. charge slip, and register

2.1. Wait for initial assessment. 2.1. Take vital signs. 10 minutes Nurse

3. Pay applicable fees 3. Receive charge slip and P200 = B 20 minutes OPD Cashier
OPD Cashier Annex Bldg payment. Issue official receipt (OR). P150 = C1
P100 = C2
Make sure to get official receipt. P50 = C3
P0 = D
3.1. Show official receipt and return charge 3.1 Receive charge slip, check and return OR. Clerk
slip.

3.2. Wait for the number to be flashed. 3.2. Instruct patient to wait for number to be Clerk
flashed/called.

4. Once number is called/flashed, proceed to 4. Examine/ assess and analyze laboratory None 3 hours Adult/ Pedia Pulmo Fellow
Room 4 for check-up. results. Adult/ Pedia TCVS Fellow

5. Proceed to nurse table for instructions. 5. Carry out doctor's orders, give instructions None 20 minutes Nurse
and schedule for the next follow-up check-up.

TOTAL 4 hours and 10 minutes

End of Transaction
Radioimmunoassay Blood Tests
Measurement of various hormones using the radioimmunoassay method.

Office or Division: Nuclear Medicine Division

Classification: Simple
Type of Transaction: G2C

Who may avail: All

CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Doctor’s Request Clinic of the referring physician.

2. OPD Card(for PHC service patient) Philippine Heart Center, Out Patient Division.

3. Ancillary and/or laboratory results and Laboratory and/or referring physician

medication prescriptions

4. Official Receipt of payment - Will be provided upon payment at the Treasury office.
(Official receipt from the Treasury office)

5. Other documents which maybe

Accepted as proof of payment. -DOH, PCSO
(HMO, LOA, Service Issue Slip -HMO Coordinator
(Guarantee Letters etc) – (pending approval of the PHC administration)
as long as it is approved by
Philippine Heart Center.)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Present 1. Receive and verify None 10 minutes Administrative Assistant or

radioimmunoassay radioimmunoassay Nuclear Medical
request at the front desk. request, inform the Technologists or
price, date and time of Nuclear Radiologic
1.1 Fill-out the Nuclear release of the result. Technologist
Radioimmunoassay work-
flow sheet. 1.2 Issue Nuclear
radioimmunoassay
(Nuclear Medicine work-flow sheet.
Division, Pagbubungkos
Plaza) 1.3 Prepare and issue
charge slip.
1.4 Instruct patient to
come back after
paying.
2. Pay applicable fees at 2. Receive payment See table of fees 30 minutes Cashier I
the treasury office. Make and issue official
sure to get official receipt. receipt.

(Treasury office at
basement of the Medical
Arts Building and ground
floor of the Hospital
building)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

3. Present the official 3. Write the official None 2 minutes Administrative Assistant or
receipt and give back a receipt number on the Nuclear Medical
copy of the charge slip at charge slip and Technologists or
Nuclear Radiologic
the Nuclear Medicine front radioimmunoassay
Technologist
desk staff. logbook.

3.1 Record patients

Radioimmunoassay
information and issue
RIA number.

4. Proceed for specimen 4. Accept patient’s None 6 hours and 15 minutes Administrative Assistant
collection and processing blood in test tube if or Nuclear Medical
at the Nuclear Laboratory arrived with blood Technologists or
Nuclear Radiologic
area. specimen, otherwise
Technologist
extract blood.

4.1 Inform patient to

bring the official receipt
of payment and/or any
valid I.D./gives
authorization letter to
any representative
upon claiming the
result.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4.2 Prepare the blood Nuclear Medical Consultant
sample for running, & Fellow/resident
calibration of counter,
counting and printing of
results of
radioimmunoassay
procedure.
4.3 Check and review
the radioimmunoassay
result .
Note: Cut-off time of
extraction – 9 AM –
Monday to Friday

5. Claim result at the 5. Release the result. None 10 minutes Administrative Assistant or
Nuclear front desk on the Nuclear Medical
schedule date and sign on Technologists or
Nuclear Radiologic
the logbook.
Technologist
(Nuclear Medicine
Division, Pagbubungkos
Plaza)

Consult your doctor for interpretation of results

TOTAL: Please see annex for 7 hours and 7 minutes
table of fees

End of Transaction
Rehabilitation Services (Physical Therapy, Occupational Therapy, Speech Therapy and Wellness Program)
The rehabilitation services are offered to individuals who have various functional limitations which ultimately affect their quality of life. It is
subdivided into specialized areas of practice to cater to specific functional limitations, such as difficulty with transfers, general movement, impaired
fitness capacity, ambulation, swallowing, or speech.
Office/Division: Physical Medicine and Rehabilitation Division
Classification: Simple
Type of Transaction: G2C: Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Rehabilitation Prescription / Plan - Rehabilitation Consult / Physiatrist

2. Official Receipt - Cashier’s Office
3. Appointment Form - Physical Medicine and Rehabilitation Division – Therapist in charge

If payment is through financial

assistance/insurance/inter-agency
1. Social Service Issue Slip - PHC Social Service Division
2. Health Maintenance Organization (HMO) - HMO Coordinator
Letter Of Authorization (LOA)

FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
1. Present 1. Receive prescription
Rehabilitation plan & instruct None 10 minutes Rehab Receptionist
Prescription / plan patient to fill-out
and contact details necessary contact
(for new patients); details Reception Area, PMRD
For follow-up 1.1. Verify program
patients, present and determine
Appointment form charging
at the PMRD 1.2. Register patient
 reception area (8th in the system
Fl, MAB) (for new
patients)

FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
1.3. Issue Order of
payment /
charge slip
1.4. Instruct patient
to pay
necessary fees

For follow-up
patients, receive
appointment form
from patients
2 Pay applicable 2. Receive payment
fees at the and issue official See table of fees 20 minutes Cashier
Cashier’s Office receipt
(4th floor MAB, Cashier’s Office
Basement MAB)
and get official
receipt
3. Present Official 3 Receive official
receipt at the receipt and log the None 10 minutes Rehab Receptionist
PMRD Reception OR number in the
and wait for name logbook.
to be called for the - Inform assigned Reception Area, PMRD
procedure therapist in charge
(8th Fl, MAB) - Instruct patient for
name to be called
4. Present self for 4. Perform appropriate Physical / Occupational / Speech Therapist /
Assessment and evaluation, assessment None 2 hours Wellness Officer
Treatment at the and treatment
treatment Area (8th Treatment Area, PMRD
Fl, MAB)
5. Get schedule of 5. Reserve schedule for Physical / Occupational / Speech Therapist /
subsequent succeeding treatment None 5 minutes Wellness Officer
treatments sessions Treatment Area, PMRD
Total See Table of Fees 2 hours, 45 minutes
End of Transaction
 OPD, Emergency Semi-Private Rooms Private Rooms
including Semi-
Room (ER), Service Private / Private Rooms in
Rooms SICU/MICU/CCU Suite
PROCEDURE And Pay Wards SICU/MICU/CCU/ /PICU Rooms
PICU/NICU Isolation
Rooms
PHYSICAL THERAPY
1. Physical Therapy I 750 865 975 1,090
2. Physical Therapy II 750 865 975 1,090
3. Physical Therapy III 850 980 1,105 1,235
4. Physical Therapy IV 1,000 1,150 1,300 1,450
5. Physical Therapy V 750 865 975 1,090
6. Physical Therapy VI 1,000 1,150 1,300 1,450
7. Physical Therapy VII 650 750 845 945
8. Physical Therapy VIII 450 520 585 655
9. Physical Therapy IX 600 690 780 870
10. Physical Therapy X 600 690 780 870

ADDITIONAL PHYSICAL THERAPY MANAGEMENT

1. Hot pack 150 175 195 220
2. Cold pack 150 175 195 220
3. Paraffin Wax Bath 150 175 195 220
4. TENS 150 175 195 220
5. Infrared Radiation 150 175 195 220
6. Ultraviolet Radiation 150 175 195 220
7. Ultrasound 150 175 195 220
8. Cervical Traction (ICT) 150 175 195 220
9. Lumbar Traction (ILT) 150 175 195 220
10. Motorpoint//FES/ES 150 175 195 220
11. IPC/Jobst Compression 150 175 195 220
12. Taping 150 175 195 220
13. Biofeedback 150 175 195 220
14. Tilt Table 200 230 260 290
15. Cyber Leg Press 150 175 195 220
16. Cyber Shoulder Press 150 175 195 220
17. ProStar Lats Pull Down 150 175 195 220
18. Endolaser 150 175 195 220

NEW ADDITIONAL PHYSICAL THERAPY

MANAGEMENT
1. Motomed 150 175 195 220
2. Treadmill 150 175 195 220
3. Abs/Back Machine 150 175 195 220
4. Stationery Bike 150 175 195 220
5. Dual Adjustable Pulley 150 175 195 220
6. Active Lifter 200 230 260 290

WELLNESS
1. Wellness I 750 865 975 1,090
2. Wellness II 800 920 1,040 1,160
3. Wellness III 600 690 780 870
 OCCUPATIONAL THERAPY
1. Occupational Therapy I 600 690 780 870
2. Occupational Therapy II 600 690 780 870
3. Occupational Therapy III 600 690 780 870
4. Occupational Therapy IV 600 690 780 870
5. Occupational Therapy V 600 690 780 870
6. Occupational Therapy VI 250 290 325 365

SPEECH AND LANGUAGE THERAPY (SLP)

1. SLP I (Assessment and Evaluation) 600 690 780 870
2. SLP II (Speech Program) 600 690 780 870
3. SLP III (Language Program) 600 690 780 870
4. SLP IV (Dysphagia Program) 600 690 780 870

SPLINTING
1. SPLINTING I 600 690 780 870
2. SPLINTING II 1550 1,785 2,015 2,250
3. SPLINTING III 3050 3,510 3,965 4,425

ELECTRODIAGNOSTIC PROCEDURE
1. EMG Myasthenia Protocol 1,550 1,785 2,015 2,250
2. EMG SSEP 1,550 1,785 2,015 2,250
3. EMG (1-2 Extremities) 1,300 1,495 1,690 1,885
4. EMG (3-4 Extremities) 1,600 1,840 2,080 2,320
5. NCV (1-2 Extremities) 1,200 1,380 1,560 1,740
6. NCV (3-4 Extremities) 1,200 1,380 1,560 1,740
7. EMG-NCV (1-2 Extremities) 2,450 2,820 3,185 3,555
8. EMG-NCV (3-4 Extremities) 2,950 3,395 3,835 4,280
9. EMG-NCV with MP 3,350 3,855 4,355 4,860
10. EMG-NCV with SSEP 3,350 3,855 4,355 4,860
Rheumatic Fever Prophylaxis
This refers to administration of Benzathine Penicillin for patients with Rheumatic Heart Disease.

Office or Division: Out-Patient Division

Classification: Simple Transactions
Type of Transaction: G2C - Government to Citizen
Who may avail: Eligible patients with rheumatic fever or rheumatic heart disease
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Benzathine Penicillin Injection Passport 1. OPD Room 3

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Proceed to OPD Room 3 and present Benzathine 1. Receive Benzathine Penicillin None 5 minutes Nurse
penicillin injection passport/ doctor's referral slip injection passport/doctor's referral slip
verify schedule

2. Sign consent/ waiver for injection. 2. Explain and ensure None 15 minutes Nurse
completeness of obtained
consent.

3. For first time patients, proceed to injection 3. Perform skin testing of None 30 minutes Nurse
room for skin testing. Benzathine Penicillin and reading Adult/ Pedia Cardio Fellow
of skin test thereafter.

3.1. Wait for administration of Benzathine 3.1. Obtain initial vital signs. None 30 minutes Nurse
Penicillin. Administer Benzathine Penicillin
according to hospital policy.
Monitor and check post-
injection vital signs.

4. Receive instructions and get the next schedule of 4. Accomplish details of injection None 15 minutes Nurse
administration of Benzathine Penicillin. given at the Benzathine Injection
Passport. Give instructions for
next schedule of injection
and relevant health teachings.

TOTAL None 1 hour and 35 minutes

End of Transaction
 Scheduled Hemodialysis Procedure
Definition of Service - Hemodialysis is a kind of treatment for patients suffering from Acute Kidney Injury (AKI) or Chronic Kidney Disease
(CKD). This procedure needs specialized care by the nephrologist and trained medical and nursing staff.

Office/Division: Renal & Metabolic Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Advisory Letter for OPD with the given Renal & Metabolic Division ( RMD), Nurses Station
schedule ( Original copy)

2. Photocopy of the last three hemodialysis flow Previous dialysis center ( if any)
sheet ( if applicable )

If payment is through financial assistance/ insurance

1.Guarantee Letter
1.1 Service Issue Slip (SIS) -DOH, PCSO,
2.Health Maintenance Organization -PHC Social Service Division
(HMO) Letter Of Authorization (LOA) - HMO Coordinator
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present requirements 1. Receive & verify None 10 minutes Renal nurse
requirements Nurses Station, RMD
1.1 Get a schedule of
procedure at the nurses 1.1 Instruct / orient patient
station of Renal & on procedure, assess
Metabolic Division (RMD) patient's status, check
vascular access.
1.2 Schedule the patient
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Admit patient
2. Fill out and sign 2.1 Charge dialysis cost None 20 minutes Data encoder & Billing,
applicable document at 2.2 Issue out applicable Customer Service Area
the patient waiting area forms (RMD)
2.3 Assists client in filling
out of forms

3. Pay Applicable Fees Receive payment and issue A. New dialyzer P 30 minutes Cashier , Customer
Official Receipt (OR), 4,800.00 + 500.00 Service Area, RMD
 Cashier at approved & sign Notice of ( PF )= P 5,300.00
Customer Discharge
Service B.
area of Reuse dialyzer
Renal & P 3,700.00 + 500.00
Metabolic ( PF) = P4,200
Division, 3rd
floor Annex Note: Senior Citizen,
10 AM-12NN PWD, Government
3:30 PM- 5PM employee less 20%
discount
 Cashier at
the Patient with Guaranteed
Basement Letter, HMO, &
of the Philhealth will pay in
hospital excess of their coverage
building + P 500.00 PF for non-
Philhealth

4. Present Official 4. Record patient data and None 5 minutes Data encoder
Receipt to Data Encoder OR number Customer Service area
at customer service area. RMD
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

5. Write Name at patient's 5. Call the patient's name, None 4 hours & 30 minutes Renal Nurse &
Logbook for queing and start requested Laboratory Technician-
cooperate during hemodialysis procedure Treatment Room, RMD
hemodialysis

6. Wait for 6. Performs termination None 15 minutes Renal Nurse

Termination & Post process of hemodialysis Treatment Room, RMD
Procedural Care procedure

6.1 Instructs patients on

post dialysis care and
inform succeeding
schedule.

7. Present approved 7. Check ,verify & sign None 3 minutes Renal Nurse
Notice of Discharge Notice of Discharge RMD, Nurses station

8. Present Approve
8. Check ,verify & collect
Notice of Discharge at None 2 minutes Guard on duty at the
Notice of Discharge
guard on duty Entrance/Exit RMD
Total Depends on category 6 Hours
End of Transaction
SCREENING (Initial OPD Consultation)
This refers to initial consultation where patients are evaluated and admitted to OPD if found to have Cardiovascular Disease, otherwise they are discharged
or referred to other government agencies capable of providing their health needs.

Office or Division: Out-Patient Divison

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. If applicable, referrral letter 1. Concerned doctors or agencies

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Secure a queue number (Maximum of 50 1. Issue queue number and instruct None 5 minutes Clerk
patients are served daily) patient to wait for number to be
Public Assistance Complaint Desk OPD called/flashed.
Waiting Area Annex Building

2. Once number is called /flashed, 2. Receive and check queue number, None 15 minutes Clerk
proceed to Room 1 & present queue number. give intruction to fill out time and motion Nurse
slip, register and issue charge slip Clerk
Make sure to keep queue number. 2.1 Interview and take vital signs
2.2 Return queue number

3.Pay applicable fees 3. Receive payment and issue P 200 20 minutes OPD Cashier
OPD Cashier Annex Building official receipt.

Make sure to get official receipt.

4. Present official receipt,return charge 4. Receive charge slip, check 10 minutes Clerk
slip and time and motion slip and return official receipt.

4.2. Instruct to wait for number to

be called/flashed.

5. Once number is called/flashed proceed to 5. Interview, examine and analyze None 2 hours and 55 minutes OPD Cardio Fellow
Room 1 for doctor's consultation. laboratory results for proper disposition

6. Proceed to nurse table for instructions. 6. Carry out doctor's orders and give None 15 minutes OPD Nurse
instructions.
6.1. If assessed as cardiovascular case,
refer to social service (Window 1 or 2)
6.2. If for further laborator work ups,
refer to diagnostic units.
6.3 If non-cardiac , discharge and refer
to other agencies.

TOTAL: None 4 hours

(first 25 patients)
End of Transaction
 PHILIPPINE HEART CENTER
OUT- PATIENT DIVISION
RATES – AUGUST 1, 2018

Hospital PF Total

ECG 460.00 90.00 550.00

Consultation fee 200.00

- new patients and
- unscheduled patients

OPD Card 30.00

Benzathine Penicillin Injection Fee* 500.00

for Pediatric and Adult RF RHD
pay patients

*Effective August 13, 2019

Six Minute Walk Test
A simple evaluating tool to assess the functional capacity of a patient by walking in a metered track at pre-determined time.

Office/Division: Pulmonary Medicine Division/Pulmonary Rehabilitation Unit

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All ambulatory patients who can follow instructions
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request of Procedure ( 1 original copy) Doctor's clinic
If payment is through financial assistance;

1.Service Issue Slip –Social

Service Division
2.Guarantee Letter/Letter of Authorization –HMO Coordinator

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present requirements 1. Receive None 5 minutes RT Coordinator
and get a schedule of requirements CRF
procedure at the Pulmonary Rehabilitation Unit
pulmonary rehabilitation 1.1 Instruct patient Reception area
reception area MAB 8th about the procedure
floor
1.2 Schedule patient
2. Fill-out information sheet 2. Assist client in None 10 minutes RT Coordinator
and consent form filling out forms CRF
2.1. Get vital signs Pulmonary Rehabilitation Unit
Reception area
3. Cooperate during 3. Assist patient in the None 10 minutes RT Coordinator
performance of procedure performance of the CRF
procedure Pulmonary Rehabilitation
Unit metered track
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING PERSON RESPONSIBLE
TIME
4. Receive charge slip 4. Issue charge slip Procedure 30 minutes 3. RT Coordinator
and pay applicable fees 4.1. Receive P 500.00 Pulmonary Rehabilitation
at Cashier's office ground payment and Unit
floor lobby or Basement issue Official Professional fee Reception area
receipt (OR) P300.00
Make sure to get OR 3.1 Cashier 1 or 2
Cashier's office GF
+ nasal cannula and lobby or Basement
use of oxygen tank
if needed
5. Present official receipt 5. Record patient data None 2 minutes RT Coordinator
Pulmonary rehab reception and OR receipt CRF
area MAB 8th floor Pulmonary rehabilitation
Unit
Reception area

6. Claim result 6. Release of result None 3 minutes CRF

Consult your doctor for interpretation of results
P 800.00 1 hour

Total + nasal cannula and

use of oxygen tank
if needed
End of Transaction
Use of Oxygen for first 30 minutes

LPM Price

1-2 lpm P 25.00

2-3 lpm P 30.00

3-4 lpm P 35.00

4-6 lpm P 40.00

Use of Medical Supply

Nasal cannula adult P 27.00

Nasal Cannula pedia P 34.00

Smoking Cessation Program
An 8 week comprehensive program to help smokers quit smoking.

Office/Division: Pulmonary Medicine Division/Pulmonary Rehabilitation Unit

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All current smokers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.None or Request of Procedure (1 original copy) Doctor's clinic
If payment is through financial assistance;

1.Service Issue Slip –Social

Service Division
2.Guarantee Letter/Letter of Authorization –HMOCoordinator
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Present 1. Receive None 20 minutes RT Coordinator
requirements and requirements CRF
get a schedule of Pulmonary Rehabilitation Unit
procedure at the 1.1. Interview the patient Reception area
pulmonary and Instruct patient about
rehabilitation the procedure
reception area 1.2. Schedule patient
MAB 8th floor
2. Fill-out information 2. Assist client in None 5 minutes RT Coordinator
sheet and consent filling out forms CRF
form Pulmonary Rehabilitation Unit
Reception area
3. Receive charge slip and 3. Issue charge slip Package I 30 minutes 3. RT Coordinator
pay applicable fees at P 2,500.00 Pulmonary Rehabilitation
Cashier's office ground 3.1 Receive payment and Unit
floor lobby or Basement issue Official Receipt (OR) Professional
3.1 Cashier 1 or 2
fee
Cashier's office GF
 Make sure to get OR P 1,000.00 Lobby or Basement
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
4. Present official receipt 4. Record patient data None 5 minutes RT Coordinator
and OR receipt CRF
Pulmonary Rehabilitation Unit
Reception area

5. Cooperate during 5. Assist patient in the None 1 hour RT Coordinator

performance of performance of the CRF
procedure procedure Pulmonary Rehabilitation
Unit
Smoking Cessation Clinic

6. Claim result 6. Release of result None Upon completion of CRF

8 sessions

Consult your doctor for

interpretation of results
Total P 3,500.00
End of Transaction
Splint Fabrication
Splint fabrication is the individual design and molding of a splint made of thermoplastic material specific to a patient’s condition. A splint
is made as per a physiatrist’s referral in order to protect the structure at risk from injury, position the joint for function, immobilize a
specific area for healing, restrict undesired motion, correct or prevent deformity or substitute for absent or weak muscles. A splint is used
in conjuction with other treatments to enhance the occupational performance of the patient.

Office/Division: Physical Medicine and Rehabilitation Division

Classification: Simple
Type of Transaction: G2C: Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Request for Splint Fabrication - Rehabilitation Consult / Physiatrist

2. Official Receipt - Cashier’s Office
If payment is through financial assistance/insurance/inter-
agency
1. Social Service Issue Slip - PHC Social Service Division
2. Health Maintenance Organization (HMO) Letter Of - HMO Coordinator
Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present doctor’s 1. Receive doctor’s request &
request for splint instruct patient to fill-out None 10 minutes Rehab Receptionist
fabrication and necessary contact details
contact details (for 1.1. Register patient in the
new patients) at the system (for new patients) Reception Area, PMRD
th
PMRD reception, (8 1.2. Confirm with orthotist the
fl, MAB) type of splint
1.3. Issue Order of payment /
charge slip
1.4. Instruct patient to pay
necessary fees
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Pay applicable fees at 2. Receive payment and issue See table of fees
the Cashier’s Office official receipt 20 minutes Cashier
(4th floor MAB,
Basement MAB) and Cashier’s Office
get official receipt
3. Present Official 3. Record Official Receipt number Rehab Receptionist
Receipt and wait for in the logbook and inform the None 10 minutes
name to be called by orthotist
the orthotist at the Reception Area, PMRD
PMRD Reception
area, (8th Fl, MAB)
1. Present self for 3 Fabricate necessary splint and None 3 Days Orthotist / Occupational
measurement and issue claim slip on when then Therapist
initial fitting at the splint will be available for final
occupational therapy fitting and pick-up Occupational Therapy
room, (8th fl, MAB) Room, PMRD
2. Present Claim Stub 5 Release of Splint None 20 minutes Orthotist / Occupational
on the day of claiming 2.1. Receive claim stub Therapist
at the reception area, 2.2. Orthotist will do final fitting
(8th fl, MAB) and adjust when necessary Occupational Therapy
2.3. Instruct patient on use and Room, PMRD
care of the splint
2.4. Give the splint to the
patient
2.5. Instruct the patient to sign
at the Splint logbook
Total See Table of Fees 3 Days and 1 hour
End of Transaction
 PHILIPPINE HEART CENTER
PULMONARY MEDICINE DIVISION

RATES – AUGUST 01, 2018

Patients in OPD, Patients in Semi-Private Patients in Private

Emergency Room (ER) Rooms including Rooms including Patients
Service and Pay Wards Semi-Private Rooms in Private Rooms in in
Suite
PROCEDURE SICU/MICU/CCU/PICU SICU/MICU/CCU/PICU Rooms
NICU/Isolation Rooms
LAB PF TOTAL LAB PF TOTAL LAB PF TOTAL LAB PF TOTAL
PULMONARY LABORATORY
1 Arterial Blood Gas Determination 715 85 800 825 100 925 930 110 1,040 1,050 120 1,170
2 ABG with electrolytes determination 895 105 1,000 1,030 120 1,150 1,150 135 1,285 1,300 155 1,455
3 ABG with lactate 805 95 900 925 110 1,035 1,050 125 1,175 1,150 135 1,285
4 Complete ABG panel 1,070 130 1,200 1,230 150 1,380 1,400 170 1,570 1,550 180 1,730
5 DLCO 2,330 200 2,530 2,680 230 2,910 3,050 260 3,310 3,400 290 3,690
6 Exhaled Nitric Oxide Determination w/monitoring 1,555 1,555 1,790 1,790 2,000 2,000 2,250 2,250
7 Forced Oscillatory Technique Procedure 850 850 980 980 1,100 1,100 1,250 1,250
8 Inhalation therapy 200 200 230 230 260 260 290 290
9 Lung volume studies 1,050 150 1,200 1,210 175 1,385 1,350 195 1,545 1,500 220 1,720
10 Nasal High Flow Oxygen Therapy Initial 1,200 1,200 1,380 1,380 1,550 1,550 1,750 1,750
11 Nasal High Flow Oxygen Therapy/Day 1,100 1,100 1,250 1,250 1,450 1,450 1,600 1,600
12 Pleural pH det 750 750 865 865 1,000 1,000 1,100 1,100
13 Pulse OX Monitoring 12 hrs 560 560 645 645 730 730 810 810
14 Pulse OX Monitoring 24 hrs 840 840 965 965 1,100 1,100 1,200 1,200
15 Simple Spirometry (PFT) 930 130 1,060 1,050 150 1,200 1,200 170 1,370 1,350 190 1,540
16 Spirometry (pre/post) 1,290 200 1,490 1,500 230 1,730 1,700 260 1,960 1,850 290 2,140
17 Spirometry with Bronchoprovocation 1,350 200 1,550 1,550 230 1,780 1,750 260 2,010 1,950 290 2,240
18 Spirometry (complete) 3,020 500 3,520 3,450 575 4,025 3,950 650 4,600 4,400 725 5,125
19 Spirometry Pedia 2,280 180 2,460 2,600 210 2,810 2,950 235 3,185 3,300 260 3,560
20 Spirometry Neonates 2,075 180 2,255 2,400 210 2,610 2,700 235 2,935 2,150 260 2,410
21 Sputum induction 500 500 575 575 650 650 725 725
22 Use of BIPAP Machine 1,200 1,200 1,400 1,400 1,550 1,550 1,750 1,750
23 Use of Bubble CPAP Machine (1-12 hrs) 650 650 750 750 850 850 950 950
24 Use of Bubble CPAP Machine (12-24 hrs) 700 700 805 805 910 910 1,000 1,000
25 Use of Microprocessor Ventilator -12 hours 2,350 2,350 2,705 2,705 3,050 3,050 3,400 3,400
26 Use of Microprocessor Ventilator -24 hours 2,500 2,500 2,850 2,850 3,250 3,250 3,650 3,650
27 Use of Mechanical Percussor 200 200 230 230 250 250 290 290
28 Use of Transport Ventilator 1-12 hours 1,000 1,000 1,150 1,150 1,300 1,300 1,450 1,450
29 Use of Transport Ventilator 24 hours 1,880 1,880 2,150 2,150 2,450 2,450 2,750 2,750
30 Venous Bicarbonate HCO3 determination 750 750 865 865 975 975 1,100 1,100
BRONCHOSCOPY PROCEDURE
31 Bronchoscopy Procedure 10,200 10,200 11,750 11,750 13,250 13,250 14,800 14,800
Bronchoscopy Package I 13,100 13,100 15,050 15,050 17,050 17,050 19,000 19,000
 Bronchoscopy Package II 10,500 10,500 12,100 12,100 13,650 13,650 15,250 15,250
Bronchoscopy Package III 10,400 10,400 11,950 11,950 13,500 13,500 15,100 15,100
Bronchoscopy Package IV 12,600 12,600 14,500 14,500 16,400 16,400 18,250 18,250
Bronchoscopy Package V 12,900 12,900 14,850 14,850 16,800 16,800 18,700 18,700
Bronchoscopy Package VI 12,600 12,600 14,500 14,500 16,400 16,400 18,250 18,250
Bronchoscopy Package VII 10,700 10,700 12,300 12,300 13,900 13,900 15,500 15,500

Note: Bronchoscopy Procedures exclude Professional Fees of Bronchoscopist

SLEEP STUDIES
32 Diagnostic 7,560 3,240 10,800 7,560 3,240 10,800 7,560 3,240 10,800 7,560 3,240 10,800
33 Therapeutic 11,560 3,240 14,800 11,560 3,240 14,800 11,560 3,240 14,800 11,560 3,240 14,800
34 Split 19,560 3,240 22,800 19,560 3,240 22,800 19,560 3,240 22,800 19,560 3,240 22,800
35 Essential Test (Apnea Link) 5,000 1,000 6,000 5,000 1,000 6,000 5,000 1,000 6,000 5,000 1,000 6,000
36 MSLT/MWT 9,800 1,000 10,800 9,800 1,000 10,800 9,800 1,000 10,800 9,800 1,000 10,800
PULMO REHABILITATION PROGRAM
PACKAGE
37 Pulmonary Rehab Program Package w/o CPET 15,500 1,000 16,500 17,850 1,150 19,000 20,150 1,300 21,450 22,500 1,450 23,950
38 Pulmonary Rehab Program Package with CPET 20,000 1,000 21,000 23,000 1,150 24,150 26,000 1,300 27,300 29,000 1,450 30,450
39 Cardio Pulmonary Exercise Test (CPET) 6,600 800 7,400 7,600 920 8,520 8,600 1,040 9,640 9,550 1,160 10,710
40 Follow up exercise/per session rehab 450 450 520 520 585 585 650 650
41 Pre-flight Assessment Test 3,000 500 3,500 3,450 575 4,025 3,900 650 4,550 4,350 725 5,075
42 Six minute walk 500 500 575 575 650 650 725 725
43 Indirect Calorimetry 2,300 2,300 2,645 2,645 3,000 3,000 3,350 3,350

44 Use of Carbon Monoxide Analyzer* 300 300 350 350 400 400 450 450

45 Smoking Cessation Package (6 sessions)* 2,500

* Effective August 1, 2019
Sputum Induction
Procedure done to help patients to collect sputum for laboratory test.

Office/Division: PULMONARY MEDICINE DIVISION/PULMONARY LABORATORY

Classification: SIMPLE

Type of Transaction G2C

Who may avail: 7 years old and above

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Doctor's request Attending Physician – Clinic Room
For service patients
 Service OPD card Social Service Division – Annex Bldg.
If payment is through financial assistance/HMO
1. Service Issue Slip (SIS) Social Service Division – Annex Bldg.
2. Health Maintenance Organization (HMO) Letter HMO Coordinator
of Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Present requirements and fill 1. Receive requirements None 10 Minutes Clerk III
out patient data slip at Pulmonary Laboratory Reception
Pulmonary Laboratory 1.1 Check doctor's Area
reception, Ground Floor, request
Hospital Bldg. 1.2 Issue patient data slip
1.3 Instruct the patient to
wait for name to be called.
2. Cooperate during the 2. Instruct and explain. None 20 Minutes Respiratory Therapist
performance of the procedure at Pulmonary Laboratory Extraction
the Pulmonary Laboratory 2.1 Assist patient in the area
extraction area. performance of procedure.
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
3. Receive charge slip and pay 3. Issue charge slip Sputum 35 Minutes Clerk III
applicable fees at designated Induction Pulmonary Laboratory
Cashier area. 3.1 Instruct client to pay - P 500.00 Reception Area
*Hospital Lobby, near stairway, applicable fees and to NSS 10ml –
Monday to Fridays 8 am - 9 pm return to Pulmonary P 17.00
*Basement Cashier – Monday to Laboratory reception after
Sunday 8 am – 7:30 pm payment

3.1 Secure official receipt

4. Present official receipt at 4. Receive official receipt None 5 Minutes Clerk III
Pulmonary Laboratory reception Pulmonary Laboratory Reception
area and bring specimen at 4.1 Instruct patient to area
Laboratory Medicine, Annex bring specimen to
Bldg., Mezzanine Laboratory Medicine,
Annex Bldg., Mezzanine
.
Total P 517.00 1 Hour 10 Minutes

End of Transaction
SURGICAL PACKAGE DEAL
This is an initiative of the hospital to simplify its treatment packages and provide patients with a hassle-free approach to process their
financial arrangement with the hospital. Numerous treatment options can be availed covering a total of a particular procedure which
comprises the bulk of cases being performed in the hospital.

Office/Division: Department of Surgery & Anesthesia

Classification: Simple
Type of Transaction G2C: Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Surgical Package Contract ( 6 original copies; - Surgery Office / Doctor's Clinic / Admitting
Signed Conforme
2. Official Receipt - Cashier's Office

If payment is through financial assistance/ insurance/

inter-agency
1. Guarantee Letter - DOH (Thru Social Service - Annex Bldg )
2. Health Maintenance Organization (HMO) with - HMO Coordinator
Manager's Check

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Get queue number at 1. Log patient’s details
Surgery office and present/ Get None 10 minutes ( upon Surgical Package
duly accomplished SPD 1.1 Receive / submission of queue Coordinator/ Staff on duty
contract and sign the conforme. counter check number)
SPD contract
and provide
conforme
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Submit completed 2. Call correspon -
Surgical Package contract ponding queue None 20 minutes Surgical Package
and conforme number and Coordinator/ Staff on duty
receive accom -
plished Surgical
Package
contract for
processing and
orientation
3. Proceed to Deputy 3. Approval of
Executive Director, for Surgical None 15 minutes DEDHSS Staff
Hospital Support Services Package by
(DEDHSS) DEDHSS
4. Proceed to Surgery Office 4. Receive None 5 minutes Surgical Package
and receive 6th copy of requirements Coordinator/ Staff on duty
Surgical Package contract
for filling
5. Proceed and pay applicable 5. Secure Official See table of fees 30 minutes Cashier
fees at the Treasury Division Receipt
- Basement or at Hospital 5.1 Schedule for
lobby (Ground flr ) Surgery
6. Present Contract for 6. Receive and
admission process None 20 minutes Admitting Staff
admission
7. Proceed to unit of 7. Assist the
admission patient for None 15 minutes Admitting Staff
admission
Total See table of fees 2 hours

End of Transaction
 PHILIPPINE HEART CENTER
ANESTHESIA

RATES – AUGUST 1, 2018

USE OF ANESTHESIA EQUIPMENT

PROCEDURE RATES

1 Anesthesia Machine (for the first 5 hours) 3,600.00

Succeeding hours (Anesthesia Machine 1,050.00/hr
2 Ambu Bag ( per use ) 680.00
3 Blood Warmer 300.00
4 Capnomac 710.00
5 Cardiac Monitor (Anesthesia Monitor-HP, for the first 4 hours) 2,600.00
Succeeding hours (Cardiac Monitor) 710/hr.
6 Syringe Pump 1,505.00 per use
7 Transport Monitor 2,330.00
8 Use of COCI with module 565.00
9 CMAC flexible laryngoscope fee per use 1,000.00
 VASCULAR CONSULTATION
Outpatient vascular consultation is a general and specialty clinic for service patients held every Tuesday to Friday from 1:00 pm to 4:00
pm. Tuesday and Thursday – Aortic Disease, Wednesday – Peripheral Arterial Disease, Friday - Venous Disease and Miscellaneous
Disorder Thursday – Post Operative follow-up, Tuesday to Friday – High Risk Foot Screening.

Office/Division: Vascular Medicine Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request of procedure (1 original copy) Attending Physician

2. OPD card (For service patient) Social Service

Payment through financial

Assistance/insurance
- Service Issue Slip (if applicable) (1 original copy) PHC Social Service
- Health Maintenance Organization (HMO)
- Letter of Authorization (LOA) with validity date HMO Coordinator

3. Official Receipt/valid ID or authorization letter if official Patient or Authorized Representative

result will be claimed by a representative
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present Out Patient 1. Check OPD card and referral None 30 minutes Vascular clerk
Division card and slip if properly scheduled.
referral slips
1.1 Register patient and issue
(Vascular Lab Annex charge slips Cashier at OPD
bldg, Ground floor)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Pay applicable fees 2. Record Official Receipt Cat. B 290 Cat. c1 20 minutes Vascular clerk
number 217.50 Cat. c2 145
(OPD Cashier, Cat. c3 72.50 Cardio research fellow / Fellow
Pathology Cashier, 2.1 Prepare chart and forward SC/GVT. 232
Hospital Building to Clinical Research and Cardio Cat. D No fee Vascular clerk
Cashier, MAB basement fellow .
Cashier)
2.2 Instruct patient to wait for
Make sure to get official name to be called
receipt
3. Present Official 3. Once name is called, None 30 minutes Cardio research fellow / Fellow
receipt (Vascular proceed to vascular clinic for
Reception) and consultation
cooperate during
consultation 3.1 Evaluate patient, prescribe
medications and/or laboratory
test

4. Proceed to Vascular 4. Schedule and instruct patient None 10 minutes Vascular clerk
Reception to get follow- for next follow-up check-up
up schedule
Cat. B 290 Cat. c1 1 hour and 30 mins
Total 217.50 Cat. c2 145
Cat. c3 72.50
SC/GVT. 232
Cat. D No fee
End of Transaction
 VASCULAR PROCEDURE
Non-invasive procedures that examine the peripheral vascular system.

Office/Division: Vascular Medicine Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request of procedure (1 original copy) Attending Physician

2. OPD card (For service patient) Social Service

Payment through financial

Assistance/insurance
- Service Issue Slip (if applicable) (1 original copy) PHC Social Service
- Health Maintenance Organization (HMO)
- Letter of Authorization (LOA) with validity date HMO Coordinator

3. Official Receipt/valid ID or authorization letter if official Patient or Authorized Representative

result will be claimed by a representative
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present request to vascular 1. Receive patient's * See table of fees 20 minutes Vascular lab clerk
lab (Annex bldg, Ground floor) request form and issue
and pay applicable fees charge slip Charge nurse

1.1 Get charge slips and pay 1. Receive and verify Vascular technologist
applicable fees make sure to patient's request form and
get official receipt charge slip Vascular Reception Area

1.2 Forward request and 1.1 Call the ward to bring WARD (in-patient)
charge slips to vascular lab the patient at the unit
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Proceed to vascular lab 2. Prepare work station None 20 minutes Vascular Technologist
for procedure and Log
2.1 Present official receipt to patient's information Vascular work station
vascular lab
2.1 Receive official
receipt and copy official
receipt number and
instruct to wait for name
to be called
3. Cooperate in medical history 3.Take medical history, None 15 minutes Vascular Technologist
and taking vital signs prepare and instruct
patient for procedure Vascular work station

4. Cooperate during 4. Perform vascular None 2 hours Vascular technologist, Clinical

performance of procedure procedure Research and Cardio fellow

Vascular work station

5. Get schedule of claiming of 5. Instruct patient to come None 3 days Vascular Reception Area
result back for the result

6. Claim the result on the

scheduled date.

Consult your doctor for

interpretation of results
TOTAL None 3 days and 3 hour 30
minutes
End of Transaction
 PHILIPPINE HEART CENTER
VASCULAR MEDICINE DIVISION

RATES – AUGUST 1, 2018

Patients in Semi-
Patients in OPD, Private Patients in Private
Emergency Room (ER) Rooms including Rooms including Patients
PROCEDURE Service and Pay Wards Semi-Private Rooms in Private Rooms in in
Suite
SICU/MICU/CCU/PICU SICU/MICU/CCU/PICU Rooms
NICU/Isolation Rooms
Hospi TOTA Hospi TOTA Hospi TOTA Hospi TOTA
tal PF L tal PF L tal PF L tal PF L
1 Abdominal Aorta Duplex Scan 4,330 600 4,930 5,000 690 5,690 5,650 780 6,430 6,300 870 7,170
2 Abdominal Aorta Screening 1,540 330 1,870 1,750 380 2,130 2,000 430 2,430 2,250 480 2,730
3 Abdominal Duplex Scan with Graft package 5,000 1,000 6,000 5,750 1,150 6,900 6,500 1,300 7,800 7,250 1,450 8,700
4 ABI/intima media/flow mediated 1,625 200 1,825 1,850 230 2,080 2,100 260 2,360 2,350 290 2,640
5 Allens Test 1,600 150 1,750 1,850 170 2,020 2,100 195 2,295 2,300 220 2,520
6 Ankle/Brachial Index 1,600 110 1,710 1,850 130 1,980 2,100 145 2,245 2,300 160 2,460
7 Arterial Duplex with ABI package 5,700 800 6,500 6,550 920 7,470 7,400 1,040 8,440 8,250 1,160 9,410
7
A Arterial Duplex with ABI – Bedside* 6,850 950 7,800 7,850 1,100 8,950 8,900 1,250 10,150 9,900 1,400 11,300
8 Arterial duplex scan upper & lower package 8,025 1,000 9,025 9,250 1,150 10,400 10,450 1,300 11,750 11,650 1,450 13,100
9 Arterial duplex with segmental package 6,600 1,000 7,600 7,600 1,150 8,750 8,600 1,300 9,900 9,550 1,450 11,000
1
0 Arterial/venous duplex package 8,025 1,000 9,025 9,250 1,150 10,400 10,450 1,300 11,750 11,650 1,450 13,100
1
1 Carotid Duplex Scan 3,800 700 4,500 4,350 805 5,155 4,950 910 5,860 5,500 1,015 6,515
1
2 Clinic Fee 290 290 335 335 375 375 425 425
1 Cold Immersion Test 3,500 500 4,000 4,050 575 4,625 4,550 650 5,200 5,100 725 5,825
3
1 Comprehensive Pump for Lymphedema (per
4 hour) 400 400 450 450 500 500 600 0 600
1
5 Duplex of Mass 2,110 400 2,510 2,450 460 2,910 2,750 520 3,270 3,050 580 3,630
1
6 DVT Screening 1,800 500 2,300 2,070 575 2,645 2,340 650 2,990 2,610 725 3,335
1
6
A DVT Screening-Bedside* 2,150 600 2,750 2,500 700 3,200 2,800 800 3,600 3,150 850 4,000
1
7 Flow Mediated Dilatation 1,050 100 1,150 1,200 115 1,315 1,350 130 1,480 1,500 145 1,645
1
8 Graft Surveillance 4,000 600 4,600 4,600 690 5,290 5,200 780 5,980 5,800 870 6,670
1
9 Hemodialysis Access Pre-Op Evaluation 5,030 1,100 6,130 5,800 1,265 7,065 6,550 1,430 7,980 7,300 1,595 8,895
2
0 Hepato-Portal Duplex Scan 2,650 600 3,250 3,050 690 3,740 3,450 780 4,230 3,850 870 4,720
2
1 High Risk Foot Screening 700 150 850 805 175 980 910 195 1,105 1,015 220 1,235
2
2 Inferior Vana Cava Screening 1,540 330 1,870 1,750 380 2,130 2,000 430 2,430 2,250 480 2,730
2
3 Intima media thickness 525 100 625 600 115 715 700 130 830 750 145 895
2 Intermittent Pneumatic Compression for
4 Venous
Thromboembolism (per hour) 150 150 180 180 200 200 220 220
2 Decongestive Lympathic Therapy, Bandaging
5 & Exercise (Unilateral) 1,600 600 2,200 1,850 690 2,540 2,100 780 2,880 2,300 870 3,170
2 Decongestive Lympathic Therapy, Bandaging
6 & Exercise (Bilateral) 2,600 900 3,500 3,000 1,035 4,035 3,400 1,170 4,570 3,750 1,305 5,055
2
7 Renal Duplex Scan 4,330 600 4,930 5,000 690 5,690 5,650 780 6,430 6,300 870 7,170
2
8 Sclerotherapy Bilateral 3,750 4,000 7,750 4,300 4,600 8,900 4,900 5,200 10,100 5,450 5,800 11,250
2
9 Sclerotherapy Unilateral 2,200 2,000 4,200 2,550 2,300 4,850 2,850 2,600 5,450 3,200 2,900 6,100
3
0 Segmental pressure 2,850 450 3,300 3,300 520 3,820 3,700 585 4,285 4,150 655 4,805
Segmental pressure & waveform study
3 (doppler bed side) – FOR ICU PATIENT
1 ONLY 1,450 150 1,600 1,650 170 1,820 1,850 195 2,045 2,100 220 2,320
3
2 Segmental pressure with stress 3,300 450 3,750 3,800 520 4,320 4,300 585 4,885 4,800 655 5,455
3
3 Subcutaneous Tissue Measurement 900 180 1,080 1,050 210 1,260 1,150 234 1,385 1,300 260 1,560
3
4 TCD/Carotid Duplex Scan 6,600 800 7,400 7,600 920 8,520 8,600 1,040 9,640 9,550 1,160 10,710
3
5 Thoracic Outlet Syndrome 3,300 500 3,800 3,800 575 4,375 4,300 650 4,950 4,800 725 5,525
3
6 Transcrannial Duplex Scan 5,500 750 6,250 6,350 865 7,215 7,150 975 8,125 8,000 1,090 9,090
3
7 Treadmill with Arterial Testing 2,900 800 3,700 3,350 920 4,270 3,750 1,040 4,790 4,200 1,160 5,360
3
8 Treatment Fee/Wound Care 400 400 450 450 500 500 600 600
3
9 Use of Arterial Assist Device 1,700 1,700 1,950 1,950 2,200 2,200 2,450 2,450
4 Use of Electro Stimulator for Arterial and
0 Venous Disease
Arterial / Venous 185 185 200 200 250 250 300 300
4 Use of Intermittent Pneumatic Compression
1 Machine 800 800 900 900 1,050 1,050 1,150 1,150
4
2 Vein Mapping (Lower Extremity) 3,550 450 4,000 4,100 520 4,620 4,600 585 5,185 5,150 655 5,805
4
3 Venous Duplex Scan 4,425 825 5,250 5,100 950 6,050 5,750 1,075 6,850 6,400 1,195 7,595
4
3
A Venous Duplex Scan – Bedside* 5,300 1,000 6,300 6,100 1,150 7,250 6,900 1,300 8,200 7,700 1,450 9,150
4
4 Venous Refill Test 1,700 300 2,000 1,950 350 2,300 2,200 390 2,590 2,450 435 2,885

*Effective March 6, 2019

Venous Bicarbonate Test
A blood test to determine bicarbonate level among patients with metabolic acidosis.

Office/Division: PULMONARY MEDICINE DIVISION/PULMONARY LABORATORY

Classification: SIMPLE
Type of Transaction G2C
Who may avail: ALL
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Doctor's request Attending Physician – Clinic Room
For service patients
 Service OPD card Social Service Division – Annex Bldg.
If payment is through financial assistance/HMO
1. Service Issue Slip (SIS) Social Service Division – Annex Bldg.
2. Health Maintenance Organization (HMO) HMO Coordinator
Letter of Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Present requirements and fill out 1. Receive None 5 Minutes Clerk III
patient data slip at Pulmonary requirements Pulmonary Laboratory Reception Area
Laboratory reception, Ground Floor,
Hospital Bldg. 1.1 Check doctor's
request
1.2 Issue patient
data slip
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
2. Receive charge slip and pay 2. Issue charge slip Venous 20 Minutes Clerk III
applicable fees at designated Bicarbonate Pulmonary Laboratory Reception area
Cashier area. 2.1 Instruct client to – P 750.00
*Hospital Lobby, near stairway, pay applicable fees
Monday to Fridays 8 am to 9 pm and to return to
*Basement Cashier – Monday to Pulmonary
Sunday 8 am – 7:30 pm Laboratory
reception after
2.1 Secure official receipt payment
3. Present official receipt at 3. Receive official None 15 Minutes Clerk III
Pulmonary Laboratory reception area receipt Pulmonary Laboratory Reception area

3.1 Instruct patient

to wait for name to
be called.

3.2 Call Pulmonary

Fellow
4. Cooperate with blood extraction at 4. Perform blood None 10 Minutes Pulmonary Fellow
the Pulmonary Laboratory extraction extraction Pulmonary Laboratory Extraction area
area.
Respiratory Therapists
4.1 Analyze the Pulmonary Laboratory Blood Gas Machine
blood area

4.2 Encode the Clerk III

result Pulmonary Laboratory Reception area
5. Claim result at Pulmonary Release result None 5 Minutes Clerk III
Laboratory reception area Pulmonary Laboratory Reception area
P 750.00 1 Hour 10
Total
Minutes
End of Transaction
Venous Bicarbonate Test
A blood test to determine bicarbonate level among patients with metabolic acidosis.

Office/Division: PULMONARY MEDICINE DIVISION/PULMONARY LABORATORY

Classification: SIMPLE

Type of Transaction: G2C

Who may avail: ALL

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Doctor's request Attending Physician – Clinic Room

For service patients

Service OPD card - Social Service Division – Annex Bldg.
If payment is through financial assistance/ HMO
1. Service Issue Slip (SIS) - Social Service Division – Annex Bldg.
2. Health Maintenance Organization (HMO) Letter of Authorization (LOA) - HMO Coordinator

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON

PAID TIME RESPONSIBLE
1. Present requirements and fill out 1. Receive requirements None 5 Minutes Clerk III
patient data slip at Pulmonary 1.1 Check doctor's request Pulmonary Laboratory
Laboratory reception, Ground Floor, 1.2 Issue patient data slip Reception area
Hospital Bldg.
FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
PAID TIME RESPONSIBLE
2. Receive charge slip and pay 2. Issue charge slip Venous 35 Minutes Clerk III
applicable fees at designated Cashier Bicarbonate – Pulmonary Laboratory
area. 2.1 Instruct client to pay applicable fees P 750.00 Reception area
and to return to Pulmonary Laboratory
*Hospital Lobby, near stairway, reception after payment
Monday to Fridays
8 am - 9 pm
*Basement Cashier – Monday to
Sunday
8 am – 7:30 pm

2.1 Secure official receipt

3. Present official receipt at 3. Receive official receipt None 15 Minutes Clerk III
Pulmonary Laboratory Reception. Pulmonary Laboratory
3.1 Instruct patient to wait for name to Reception area
be called.

3.2 Call to inform Pulmonary Fellow.

4. Cooperate with blood extraction at 4. Perform blood extraction None 10 minutes Pulmonary Fellow
the Pulmonary Laboratory extraction Pulmonary Laboratory
area. Extraction area

4.1 Analyse the blood Respiratory Therapist

Pulmonary Laboratory
Blood Gas Machine area

4.2 Encode the result Clerk III

Pulmonary Laboratory
Reception area
FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
PAID TIME RESPONSIBLE
5. Claim result at Pulmonary 5. Release result None 5 Minutes Clerk III
Laboratory reception. Pulmonary Laboratory
Reception area
P 750.00 1 Hour 10
Total
Minutes
 End of Transaction

PHILIPPINE HEART CENTER

PULMONARY MEDICINE DIVISION

RATES – AUGUST 01, 2018

Patients in OPD, Patients in Semi-Private Patients in Private

Emergency Room (ER) Rooms including Rooms including Patients
 Service and Pay Wards Semi-Private Rooms in Private Rooms in in
Suite
PROCEDURE SICU/MICU/CCU/PICU SICU/MICU/CCU/PICU Rooms
NICU/Isolation Rooms
LAB PF TOTAL LAB PF TOTAL LAB PF TOTAL LAB PF TOTAL
PULMONARY LABORATORY
1 Arterial Blood Gas Determination 715 85 800 825 100 925 930 110 1,040 1,050 120 1,170
2 ABG with electrolytes determination 895 105 1,000 1,030 120 1,150 1,150 135 1,285 1,300 155 1,455
3 ABG with lactate 805 95 900 925 110 1,035 1,050 125 1,175 1,150 135 1,285
4 Complete ABG panel 1,070 130 1,200 1,230 150 1,380 1,400 170 1,570 1,550 180 1,730
5 DLCO 2,330 200 2,530 2,680 230 2,910 3,050 260 3,310 3,400 290 3,690
Exhaled Nitric Oxide Determination
6 w/monitoring 1,555 1,555 1,790 1,790 2,000 2,000 2,250 2,250
7 Forced Oscillatory Technique Procedure 850 850 980 980 1,100 1,100 1,250 1,250
8 Inhalation therapy 200 200 230 230 260 260 290 290
9 Lung volume studies 1,050 150 1,200 1,210 175 1,385 1,350 195 1,545 1,500 220 1,720
10 Nasal High Flow Oxygen Therapy Initial 1,200 1,200 1,380 1,380 1,550 1,550 1,750 1,750
11 Nasal High Flow Oxygen Therapy/Day 1,100 1,100 1,250 1,250 1,450 1,450 1,600 1,600
12 Pleural pH det 750 750 865 865 1,000 1,000 1,100 1,100
13 Pulse OX Monitoring 12 hrs 560 560 645 645 730 730 810 810
14 Pulse OX Monitoring 24 hrs 840 840 965 965 1,100 1,100 1,200 1,200
15 Simple Spirometry (PFT) 930 130 1,060 1,050 150 1,200 1,200 170 1,370 1,350 190 1,540
16 Spirometry (pre/post) 1,290 200 1,490 1,500 230 1,730 1,700 260 1,960 1,850 290 2,140
17 Spirometry with Bronchoprovocation 1,350 200 1,550 1,550 230 1,780 1,750 260 2,010 1,950 290 2,240
18 Spirometry (complete) 3,020 500 3,520 3,450 575 4,025 3,950 650 4,600 4,400 725 5,125
19 Spirometry Pedia 2,280 180 2,460 2,600 210 2,810 2,950 235 3,185 3,300 260 3,560
20 Spirometry Neonates 2,075 180 2,255 2,400 210 2,610 2,700 235 2,935 2,150 260 2,410
21 Sputum induction 500 500 575 575 650 650 725 725
22 Use of BIPAP Machine 1,200 1,200 1,400 1,400 1,550 1,550 1,750 1,750
23 Use of Bubble CPAP Machine (1-12 hrs) 650 650 750 750 850 850 950 950
24 Use of Bubble CPAP Machine (12-24 hrs) 700 700 805 805 910 910 1,000 1,000
25 Use of Microprocessor Ventilator -12 hours 2,350 2,350 2,705 2,705 3,050 3,050 3,400 3,400
26 Use of Microprocessor Ventilator -24 hours 2,500 2,500 2,850 2,850 3,250 3,250 3,650 3,650
27 Use of Mechanical Percussor 200 200 230 230 250 250 290 290
28 Use of Transport Ventilator 1-12 hours 1,000 1,000 1,150 1,150 1,300 1,300 1,450 1,450
29 Use of Transport Ventilator 24 hours 1,880 1,880 2,150 2,150 2,450 2,450 2,750 2,750
30 Venous Bicarbonate HCO3 determination 750 750 865 865 975 975 1,100 1,100
BRONCHOSCOPY PROCEDURE
10,20 11,75 13,25 14,80
31 Bronchoscopy Procedure 0 10,200 0 11,750 0 13,250 0 14,800
13,10 15,05 17,05 19,00
Bronchoscopy Package I 0 13,100 0 15,050 0 17,050 0 19,000
10,50 12,10 13,65 15,25
Bronchoscopy Package II 0 10,500 0 12,100 0 13,650 0 15,250
10,40 11,95 13,50 15,10
Bronchoscopy Package III 0 10,400 0 11,950 0 13,500 0 15,100
12,60 14,50 16,40 18,25
Bronchoscopy Package IV 0 12,600 0 14,500 0 16,400 0 18,250
12,90 14,85 16,80 18,70
Bronchoscopy Package V 0 12,900 0 14,850 0 16,800 0 18,700
12,60 14,50 16,40 18,25
Bronchoscopy Package VI 0 12,600 0 14,500 0 16,400 0 18,250
10,70 12,30 13,90 15,50
Bronchoscopy Package VII 0 10,700 0 12,300 0 13,900 0 15,500
Note: Bronchoscopy Procedures exclude Professional Fees of Bronchoscopist
SLEEP STUDIES
32 Diagnostic 7,560 3,240 10,800 7,560 3,240 10,800 7,560 3,240 10,800 7,560 3,240 10,800
11,56 11,56 11,56 11,56
33 Therapeutic 0 3,240 14,800 0 3,240 14,800 0 3,240 14,800 0 3,240 14,800
19,56 19,56 19,56 19,56
34 Split 0 3,240 22,800 0 3,240 22,800 0 3,240 22,800 0 3,240 22,800
35 Essential Test (Apnea Link) 5,000 1,000 6,000 5,000 1,000 6,000 5,000 1,000 6,000 5,000 1,000 6,000
36 MSLT/MWT 9,800 1,000 10,800 9,800 1,000 10,800 9,800 1,000 10,800 9,800 1,000 10,800
PULMO REHABILITATION PROGRAM PACKAGE
15,50 17,85 20,15 22,50
37 Pulmonary Rehab Program Package w/o CPET 0 1,000 16,500 0 1,150 19,000 0 1,300 21,450 0 1,450 23,950
20,00 23,00 26,00 29,00
38 Pulmonary Rehab Program Package with CPET 0 1,000 21,000 0 1,150 24,150 0 1,300 27,300 0 1,450 30,450
39 Cardio Pulmonary Exercise Test (CPET) 6,600 800 7,400 7,600 920 8,520 8,600 1,040 9,640 9,550 1,160 10,710
40 Follow up exercise/per session rehab 450 450 520 520 585 585 650 650
41 Pre-flight Assessment Test 3,000 500 3,500 3,450 575 4,025 3,900 650 4,550 4,350 725 5,075
42 Six minute walk 500 500 575 575 650 650 725 725
43 Indirect Calorimetry 2,300 2,300 2,645 2,645 3,000 3,000 3,350 3,350
44 Use of Carbon Monoxide Analyzer* 300 300 350 350 400 400 450 450
45 Smoking Cessation Package (6 sessions)* 2,500
* Effective August 1, 2019
WOUND CARE CLINIC OUT-PATIENT TREATMENT PROCESS
This provides wound care for out-patients requiring wound management such as wound debridement, disarticulation, ungiectomy
(partial/whole), incision and drainage and simple dressings.

Office/Division: Vascular Surgery Division-Wound Care Clinic

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Referral slip -Referring Physician / Doctor’s Clinic

OPD Card -Social Services Division
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
For New Patients: For New Patients: Laboratory Technician/
Wound Care Nurse
1.Proceed to wound care clinic 1. Issue queue number, None 5 minutes
to get queue number and receive referral slip, log and Wound Care Clinic,
present referral slip. line-up patient. Vascular Surgery Division,
1.1Provide wound care Ground Floor, Annex
patient profile form and building
consent form.

For Old Patients: For Old Patients:

1. Proceed to wound care 1. Log patient for line up.

clinic and get queue number.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING
PERSON RESPONSIBLE
TIME
For New Patients: For New Patients: Laboratory Technician/
Wound Care Nurse and
2. Fill out necessary forms and 2. Receive, counter-check None 30 minutes Wound Care Specialist
wait to be called. and secure completed
forms for filing. Wound Care Clinic,
2.1 Prepare and position Vascular Surgery Division,
patient for procedure. Ground Floor, Annex
2.2 Perform procedure. building

For Old Patients: For Old Patients:

2. Wait to be called and 2. Pull out client's record,

prepare for procedure. prepare and position patient
for procedure.
2.1 Perform procedure.
3. Pay attention to wound 3. Wound specialist to None 10 minutes Wound Care Nurse and
specialist's post-procedure instruct and provide post- Wound specialist
instructions. procedure instructions.
3.1 Issue request slips and Wound Care Clinic,
professional fee form Vascular Surgery Division,
(private patients). Ground Floor, Annex
building
4. Pay applicable fees 4. Receive payment and Please see posted 30 minutes Cashier
issue official receipt. List of Advanced
Cashier Office, Annex Bldg, Wound Care Treasury Division, Ground
Ground Floor, Dressings, Floor, Annex building
Basement MAB Treatment Room
Fee and
Reprocessing
Make sure to get official rates at Wound
receipt. Care Clinic.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING
PERSON RESPONSIBLE
TIME
5. Present official receipt and 5.Receive official receipt None 3 minutes Laboratory
original copy of request slip to and log official receipt Technician/Wound Care
wound care staff. number on the original copy Nurse
of the request slip.
5.1 Schedule patient for Wound Care Clinic,
next visit and issue patient Vascular Division, Ground
satisfaction survey form. Floor MAB Annex building
6. Fill out Wound Care Clinic 6. Receive the filled out None 2 minutes Laboratory
Patient Satisfaction Survey Patient Satisfaction Survey Technician/Wound Care
form and submit to wound form. Nurse
care staff.
Wound Care Clinic,
Vascular Division, Ground
Floor MAB Annex building
None 1 hour and 20
TOTAL
minutes
End of Transaction
X-Ray Procedure
Type of imaging modality that uses ionizing radiation to aid the doctor in examining the patient’s internal organ and making an accurate
diagnosis and choose the ideal treatment plan.

Office/Division: Radiological Sciences Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Request of procedure (1 original copy) Doctor’s Clinic
2.Previous result (If applicable)
3.In claiming of result kindly bring and present to reception
area the Official receipt of the patient
If payment is through financial assistance/insurance
1. Service Issue Slip (SIS) ‐PHC Social Service 
2. Health Maintenance Organization (HMO) Letter of
Authorization (LOA) -HMO Coordinator

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Present requirements for 1. Receive requirements None 3 minutes Clerk of Radiologic

procedure to X-ray Technologist
1.1Instruct patient to wait
Reception area. Ground floor for their name to be X-ray Reception Area
Hospital Building called.
2. Fill out and sign 2. Issue out applicable None 5 minutes Clerk of Radiologic
applicable document at forms and assist client in Technologist
reception area Ground floor filling out of forms
Hospital Building X-ray Reception Area

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Proceed to Cashier and 3. Receive payment and See table of fees 30 minutes Casher’s Office
Pay Applicable Fees. issue Official Receipt (OR) Basement or at the Hospital
Casher’s Office lobby beside the Elevator
Basement or at the Hospital
lobby beside the Elevator
4. Present request form with 4. Record patient data and None 5 minutes Clerk of Radiologic
Official Receipt at reception OR Number Technologist
area Ground floor Hospital
Building X-ray Reception Area
5. Proceeds to X-ray room for 5. Perform requested None 20 mins. Radiologic Technologist at
the procedure. Ground floor procedures X-ray Room
Hospital Building
5.1 Read and Interpret
images by the Medical
Officer and for final
reading by The Medical
Specialist.

5.2 Instruct the patient or

relative to come back for
the result after 1 day
6. Claim official Result at the 6 .Request patient/ None 1day Clerk of Radiologic
X-ray reception area Ground relative to sign on the Technologist
floor Hospital Building and receiving log book as
present to Attending / proof of receipt X-ray Reception Area
Referring Physician
Consult your doctor for interpretation of results
Total See table of fees 1 day
End of Transaction

PHILIPPINE HEART CENTER

 RADIOLOGICAL SCIENCES DIVISION

RATES – August 1, 2018

OPD, Emergency Room Semi-Private Rooms Private Rooms/Private

(ER), Service and Pay Including Semi-Private Rooms in SICU/MICU/
PROCEDURE Wards Rooms, SICU/MICU/CCU/ CCU/PICU SUITE ROOMS
PICU/NICU, Isolation
Rooms
Hospita Hospit Hospit TOTA
CT SCAN l PF TOTAL al PF TOTAL al PF TOTAL Hospital PF L
1,20 4,85 1,40 6,25 5,45 1,55 7,0 6,1 1,7 7,85
1. Cranial Plain 4,200 0 5,400 0 0 0 0 0 00 00 50 0
Cranial W/ 1,20 5,10 1,40 6,50 5,80 1,55 7,3 6,4 1,7 8,20
2. Contrast 4,450 0 5,650 0 0 0 0 0 50 50 50 0
10,
Head Perfusion 2,40 8,65 2,75 11,4 9,75 3,10 12, 90 3,5 14,4
3. w/ Contrast 7,500 0 9,900 0 0 00 0 0 850 0 00 00
Temporal / IAC 1,20 6,90 1,40 8,30 7,80 1,55 9,3 8,7 1,7 10,4
4. Plain 6,000 0 7,200 0 0 0 0 0 50 00 50 50
Temporal / IAC 1,20 7,50 1,40 8,90 8,45 1,55 10, 9,4 1,7 11,2
5. w/ Contrast 6,500 0 7,700 0 0 0 0 0 000 50 50 00
1,20 6,90 1,40 8,30 7,80 1,55 9,3 8,7 1,7 10,4
6. Orbit Plain 6,000 0 7,200 0 0 0 0 0 50 00 50 50
1,20 7,50 1,40 8,90 8,45 1,55 10, 9,4 1,7 11,2
7. Orbit w/ Contrast 6,500 0 7,700 0 0 0 0 0 000 50 50 00
PNS / Facial 1,20 5,60 1,40 7,00 6,30 1,55 7,8 7,0 1,7 8,80
8. Plain 4,850 0 6,050 0 0 0 0 0 50 50 50 0
PNS / Facial w/ 1,20 7,00 1,40 8,40 7,95 1,55 9,5 8,8 1,7 10,6
9. Contrast 6,100 0 7,300 0 0 0 0 0 00 50 50 00
10,
1 Neck / Naso / 1,20 8,05 1,40 9,45 9,10 1,55 10, 15 1,7 11,9
0. Oro Plain 7,000 0 8,200 0 0 0 0 0 650 0 50 00
1 Neck / Naso / 9,400 1,20 10,60 10,8 1,40 12,2 12,2 1,55 13, 13, 1,7 15,4
1. Oro w/ Contrast 0 0 00 0 00 00 0 750 65 50 00
 0
1 1,20 5,70 1,40 7,10 6,45 1,55 8,0 7,2 1,7 8,95
2. Dental Plain 4,950 0 6,150 0 0 0 0 0 00 00 50 0
1 1,20 5,85 1,40 7,25 6,65 1,55 8,2 7,4 1,7 9,15
3. Chest Plain 5,100 0 6,300 0 0 0 0 0 00 00 50 0
10,
1 1,20 8,60 1,40 10,0 9,75 1,55 11, 85 1,7 12,6
4. Chest HRCT 7,480 0 8,680 0 0 00 0 0 300 0 50 00
10,
1 Chest w/ 1,20 8,05 1,40 9,45 9,10 1,55 10, 15 1,7 11,9
5. Contrast 7,000 0 8,200 0 0 0 0 0 650 0 50 00
1 Upper Abdomen 1,20 7,35 1,40 8,75 8,30 1,55 9,8 9,3 1,7 11,0
6. Plain 6,400 0 7,600 0 0 0 0 0 50 00 50 50
Upper Abd. w/ 19,
1 Contrast (Tri- 13,50 1,50 15,00 15,5 1,75 17,3 17,5 1,95 19, 60 2,2 21,8
7. phasic) 0 0 0 50 0 00 50 0 500 0 00 00
1 Lower Pelvis 1,20 4,35 1,40 5,75 8,30 1,55 9,8 9,3 1,7 11,0
8. Abd. Plain 6,400 0 7,600 0 0 0 0 0 50 00 50 50
Lower Abd/ 13,
1 Pelvis w. 1,20 10,25 10,4 1,40 11,8 11,7 1,55 13, 15 1,7 14,9
9. Contrast 9,050 0 0 00 0 00 50 0 300 0 50 00
14,
2 Whole Abdomen 10,00 2,40 12,40 11,5 2,75 14,2 13,0 3,10 16, 50 3,5 18,0
0. Plain 0 0 0 00 0 50 00 0 100 0 00 00
Whole Abd. W/ 25,
2 Contrast (Tri- 17,35 2,60 19,95 19,9 3,00 22,9 22,5 3,40 25, 15 3,7 28,9
1. phasic) 0 0 0 50 0 50 50 0 950 0 50 00
11,
2 2,40 10,45 9,25 2,75 12,0 10,4 3,10 13, 70 3,5 15,2
2. Stonogram 8,050 0 0 0 0 00 50 0 550 0 00 00
2 Cervical Spine 1,20 7,00 1,40 8,40 7,95 1,55 9,5 8,8 1,7 10,6
3. Plain 6,100 0 7,300 0 0 0 0 0 00 50 50 00
2 Thoracic Spine 1,20 7,00 1,40 8,40 7,95 1,55 9,5 8,8 1,7 10,6
4. Plain 6,100 0 7,300 0 0 0 0 0 00 50 50 00
2 Lumbar Spine 1,20 7,30 7,00 1,40 8,40 7,95 1,55 9,5 8,8 1,7 10,
5. Plain 6,100 0 0 0 0 0 0 0 00 50 50 600
2 Whole Spine 6,100 2,40 8,50 7,00 2,75 9,75 7,95 3,10 11, 8,8 3,5 12,
6. Plain 0 0 0 0 0 0 0 05 50 00 350
 0
2 Extremeties 1,20 7,30 7,00 1,40 8,40 7,95 1,55 9,5 8,8 1,7 10,
7. Plain 6,100 0 0 0 0 0 0 0 00 50 50 600
20, 17,
2 CT-Guided 12,0 15,5 4,05 13,8 17,8 4,55 15,6 15 5,1 40 22,
8. Biopsy 3,500 00 00 0 00 50 0 00 0 00 0 500
15, 13,
2 Virtual 2,40 11,7 10,7 2,75 13,5 12,1 3,10 25 55 3,5 17,
9. Colonography 9,350 0 50 50 0 00 50 0 0 0 00 050
17,
30 Brain Perfusion 12,00 12,00 13,8 13,8 15,6 15, 40 17,4
. CT Scan* 0 0 00 00 00 600 0 00
21,
31 Cardiac Perfusion 14,65 14,65 16,8 16,8 19,0 19, 25 21,2
. CT Scan* 0 0 50 50 50 050 0 50
21,
3 Liver Perfusion 14,65 14,65 16,8 16,8 19,0 19, 25 21,2
2 CT Scan* 0 0 50 50 50 050 0 50
17,
3 Lung Perfusion 12,00 12,00 13,8 13,8 15,6 15, 40 17,4
3 CT Scan* 0 0 00 00 00 600 0 00
21,
3 Triple Rule Out 14,65 14,65 16,8 16,8 19,0 19, 25 21,2
4 CT Scan* 0 0 50 50 50 050 0 50
Contrast and Professional Fee – to be
* charged separately
Effective –
November 8,
* 2019
CT-
ANGIOGRAMS
23, 19,
13,2 5,00 18,2 15,2 5,75 20,9 17,1 6,50 65 15 7,2 26,
1. Cerebral CTA 00 0 00 00 0 50 50 0 0 0 50 400
23, 19,
13,2 5,00 18,2 15,2 5,75 20,9 17,1 6,50 65 15 7,2 26,
2. Carotid CTA 00 0 00 00 0 50 50 0 0 0 50 400
3. Thoracic CTA 13,2 5,00 18,2 15,2 5,75 20,9 17,1 6,50 23, 19, 7,2 26,
00 0 00 00 0 50 50 0 65 15 50 400
 0 0
23, 19,
13,2 5,00 18,2 15,2 5,75 20,9 17,1 6,50 65 15 7,2 26,
4. Abdominal CTA 00 0 00 00 0 50 50 0 0 0 50 400
30, 26,
18,2 5,00 23,2 20,9 5,75 26,7 23,6 6,50 15 40 7,2 33,
5. CT-Aortogram 00 0 00 50 0 00 50 0 0 0 50 650
23, 19,
13,2 5,00 18,2 15,2 5,75 20,9 17,1 6,50 65 15 7,2 26,
6. Cardiac CTA 00 0 00 00 0 50 50 0 0 0 50 400
26, 21,
15,0 5,00 20,0 17,2 5,75 23,0 19,5 6,50 00 75 7,2 29,
7. Coronary CTA 00 0 00 50 0 00 00 0 0 0 50 000
13,
CT-Coronary 6,70 3,50 10,2 7,70 4,02 11,7 8,70 4,55 25 9,7 5,1 14,
8. Calcium Score 0 0 00 0 5 25 0 0 0 00 00 800
34, 26, 11,
CT-Coronary / 18,5 8,00 26,5 21,3 9,20 30,5 24,0 10,4 45 85 60 38,
9. TAVI 00 0 00 00 0 00 50 00 0 0 0 450
23, 19,
1 13,2 5,00 18,2 15,2 5,75 20,9 17,1 6,50 65 15 7,2 26,
0. Pulmonary CTA 00 0 00 00 0 50 50 0 0 0 50 400
23, 19,
1 13,2 5,00 18,2 15,2 5,75 20,9 17,1 6,50 65 15 7,2 26,
1. Renal CTA 00 0 00 00 0 50 50 0 0 0 50 400
23, 19,
1 13,2 5,00 18,2 15,2 5,75 20,9 17,1 6,50 65 15 7,2 26,
2. Mesenteric CTA 00 0 00 00 0 50 50 0 0 0 50 400
26, 21,
1 Upper 15,0 5,00 20,0 17,2 5,75 23,0 19,5 6,50 00 75 7,2 29,
3. Extremities CTA 00 0 00 50 0 00 00 0 0 0 50 000
26, 21,
1 Lower 15,0 5,00 20,0 17,2 5,75 23,0 19,5 6,50 00 75 7,2 29,
4. Extremities CTA 00 0 00 50 0 00 00 0 0 0 50 000
22, 21,
1 15,0 2,60 17,6 17,2 3,00 20,2 19,5 3,38 88 75 3,7 25,
5. CT Urogram 00 0 00 50 0 50 00 0 0 0 50 500
Medical Services
Internal Services
Infirmary Check-up (Regular/Annual)
This refers to regular check-up annual physical examination of all PHC employees.

Office or Division: Out-Patient Division

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: All PHC employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Proceed to infirmary for consultation. 1. Prepare employee's none 10 minutes Nurse
(Appointment is encouraged) medical chart and instruct for name to
be called

2. Once name is called, proceed to 2. Examine and interpret available none 1 hour Infirmarian
Doctor's Clinic. laboratory results
2.1 Give instruction, prescription and
issue laboratory requests if needed
2.2 Return chart to patient

3. Return Medical chart to nurse and receive 6. Carry out doctor's orders, none 15 minutes OPD Nurse
instructions give instructions, schedule
for next follow-up
if needed

TOTAL: 1 hour and 25 minutes

End of Transaction
Nursing Services
External Services
Discharge of Admitted Service Patients
The process by which a service admitted patient is discharged from the hospital after medical treatment or surgical
intervention was done, transferred to another health facility for continuity of care or discharged against medical advice
due to patient/family's personal reasons.
Office/Division: Nursing and Social Service
Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All indigent/poor patients with cardiac and other cardiac related diseases
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Notice of Discharge Nurse station where patient is admitted

Philhealth pertinent documents e.g. Philhealth MDR at Philhealth office nearest patient's residence, CSF, CF4
Member Data Record (MDR), CF4,
CSF
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Receive Doctor’s 1. Issue Notice of Discharge None 1 minute Staff Nurse

verbal order of
discharge Administrative Aide VI
SSD Transaction Area
3rd Floor Annex Building

2. Present Notice of 2. Issue blood bank clearance None 5 minutes Administrative Aide VI
Discharge to Social form and instruct SSD Transaction Area
Service relative/watcher to proceed to
blood bank for clearance
Ground Floor, Annex
Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Present accomplished 2. Receive accomplished blood None 5 minutes Administrative Aide VI
blood bank clearance bank clearance form and SSD Transaction Area
form to Social Service instruct relative/watcher to wait
for number to be called

2.1 Endorse accomplished None

blood bank clearance form,
notice of discharge and SOA to
Social Worker Officer
3. Report to In-Patient 3. Conduct discharge planning None 45 minutes Social Welfare Officer I/ II
social worker in-charge
for interview and submit 3.1 Prepare necessary referrals
Philhealth forms to Fund Sources from both None
Government & Non-
  Government agencies

3.2 Prepare SS
Recommendation and submit None
to supervisor/ Chief, SSD for
approval

3.3 Review and approve SS None Chief/Supervisor

recommendation Social Service Division

3.4 Issue SS Recommendation None Social Welfare Officer I/ II

Ground Floor, Annex and Philhealth transmittal form SSD Transaction Area
Building to relative/watcher
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Claim Social Service 4. Advise to proceed to Billing None 2 minutes Social Welfare Officer I/ II
Recommendation and section to facilitate discharge SSD Transaction Area
Philhealth transmittal
form 4.1Instruct to submit to Billing
section Philhealth transmittal None 2 minutes Social Welfare Officer I/ II
form and Social Service SSD Transaction Area
recommendation

5. Submit accomplished 5. Receive accomplished None 5 minutes Administrative Aide VI

Philhealth transmittal Philhealth transmittal form, SSD Transaction Area
form and Social Service Social Service recommendation
recommendation to and issue Statement of Account
Billing Section

6. Get statement of 6. Check statement of account, Depending on 1 hour Billing Clerk and Cashier
account, present notice receive payment and approve category
of discharge and pay notice of discharge
applicable fees
7. Present approved 7. Check approved notice of None 30 minutes Nurse
notice of discharge to discharge, give Home
Nurse and get Home instructions, prescriptions and
instructions, follow up schedule.
prescriptions and follow
up schedule.
Total None 3 hours
End of Transactions
Discharge of Private Patients
Refers to discharge of private In-Patients.

Office/Division: Nursing Service

Classification: Simple
Type of Transaction G2C Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
To settle bill:

1.Notice of Discharge. - Nurse station

2.Professional Fee - Attending Physicians
3.Philhealth CF4 Form - Nurse Station
4.Philhealth CSF Form - Admitting Section
5.Member Data Record (MDR) - Philhealth Office
6.Copy of Senior Citizen Card /PWD, if applicable - Client
7.Certificate of Government Employee, if applicable - Client

Before leaving the unit:

8.Approved Notice of Discharge

9.OR/ Anesthesia Record or Angiogram records, if applicable
10.Copy of Laboratories
11.Discharge summary

If payment is through financial assistance/Insurance

1.Guarantee Letter - DOH,PCSO
2.Health Maintenance Organization (HMO) Letter of - HMO Coordinator
Authorization (LOA)

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON

 PAID TIME RESPONSIBLE
1. Receive verbal notice of 1. Inform patient of discharge. 2 hours Attending Physician
discharge from Attending 1.1 Write discharge order in the chart None Charge Nurse/
Physician in the patient room 1.2 Carry out order and prepare Bedside Nurse
Notice of discharge.
1.3 Inform all referrals if any and
prepare PF form
1.4 Prepare all the required Ward Clerk
documents
1.4.1 Notice of Discharge.
(4 original copies)
1.4.2 Philhealth CF4 (1 orig copy)
Form
1.4.3 Philhealth CSF Form (1
original copy)
1.4.4 Professional Fee
1.4.5 Copy of Diagnostic and
Laboratory results (1 set)
1.4.6. OR/ Anesthesia Record or
Angiogram records
(1 photocopy)
2. Submit requirements 2.1. Receive copy of MDR and None 30 minutes Charge Nurse/
Senior Citizen card/ PWD card Bedside Nurse

2.2. Distribute notice of discharge to Nursing

Pharmacy, Billing , Admitting Attendant
and Patient, with the complete
copy of required documents.

2.3.Stamp the notice of discharge None Billing Personnel

indicating the time it was received.
2.4.Give notice of discharge copy to
the charge nurse. Nursing Attendant
FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
PAID TIME RESPONSIBLE
 3. Receive Home 3.1. Give home instructions
Instructions, and drug prescriptions. 30 minutes Bedside Nurse
drug prescriptions in
the patient’s room 3.2 Explain utilizing METHODS
4. Receive notice of 4. Give the notice of discharge to the 5 minutes Charge nurse/
discharge copy from patient's relative and explain the process Bedside Nurse
the Charge Nurse in of billing settlement
the patient's room
5. Proceed to Billing Section, 5. Prepare Statement of Account 1 hour Billing Staff
secure a queue number and
get Statement of Account
Medical Arts Building
Medical Arts Building Basement
Basement
6. Proceed to Cashier with 6. Receive payment and issue Official 30 minutes Cashier
Statement of Account, pay Receipt
hospital bill and professional
fees Medical Arts Building
Basement
Make sure to get Official
Receipt
7. Present official receipt and 7. Check Official receipt and approved 30 minutes Charge Nurse/
approved notice of discharge notice of discharge Bedside Nurse
to the Charge Nurse at the
Nurse station 7.1. Sign the approved notice of Charge Nurse/
discharge Bedside Nurse
7.2. Transport patient to hospital
lobby Nursing Attendant
7.3. Give approved notice of
discharge to Hospital Guard
on duty Patient/relatives
7.4. Check approved notice of
FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
PAID TIME RESPONSIBLE
discharge and remove
 patient's ID band
7.5. Register in the Hospital
Guards Logbook
7.6. Give the Notice of Discharge
to the Admitting Section
8. Present approved notice of 8. Guard logs time of discharge None 5 minutes Guard
discharge to guard at hospital
exit. Hospital Exit
Total None 5 hours and 40
minutes
End of Transaction
PURCHASE OF ITEMS AVAILABLE AT CENTRAL SUPPLY SERVICES

Guide for all clients on how to purchase item/s available at Central Supply Services.

Office/Division: Central Supply Services

Classification: Simple
Type of Transaction: G2C – Government to Client
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Proceed to 1. Prepare Request * Please see Price 2 minutes Nursing

Issuance Counter Slip for the requested item. List of CSS item for Attendant II
Area of Central sale at the Issuance Central Supply Service,
Issuance Counter Area,
Supply Service, 1.1. Issue Request Counter Area of
Basement Hospital Bldg.
Basement Slip and Central Supply
Hospital Bldg. instruct to pay Services.
1.1. Request item to at the cashier
be purchased located at the
at the Issuance basement of
Counter Area of MAB Bldg.
Central Supply
Basement,
Hospital Bldg.

2. Proceed to cashier 2. Get Request Slip None 15 minutes Cashier I or

and get queuing and issue Official Cashier II
number for Receipt of payment. Cashier Office Basement,
payment located MAB Bldg.
at the basement of 2.1. Instruct
MAB Bldg. customer to
return to CSS
to claim the
 item.

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

3. Present the 3. Receive Request None 4 minutes Nursing

Official Receipt Slip together with Attendant II
together with the the Official Receipt Central Supply Service,
Issuance Counter Area,
Request Slip at
Basement Hospital Bldg.
Issuance Counter 3.1. Record
Area of Central Official Receipt
Supply Services, Number in the
Basement, Request Slip.
Hospital Bldg.

4. Receive the item 4. Issue item to customer. 2 minutes Nursing

together with the Official Attendant II
Receipt at the Issuance Central Supply Service,
Issuance Counter Area,
Counter Area of Central
Basement Hospital Bldg.
Supply Services,
Basement,
Hospital Bldg.
Please see annex
Total for table of CSS 23 minutes
fees
End of Transaction
PURCHASE OF ITEMS AVAILABLE AT LINEN SECTION
Guide for all clients on how to avail/purchase linen item/s.

Office/Division: Linen Section

Classification: Simple
Type of Transaction: G2C – Government to Client
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None
FEES TO BE PERSON
CLIENT STEPS AGENCY ACTION PROCESSING TIME
PAID RESPONSIBLE

1. Proceed to Issuance 1. Prepare Request * Please see 2 minutes Nursing

Counter Area of Linen Slip for the Price List of Attendant II
Section, Basement Hospital requested item. Linen Linen item Linen Section's, Issuance
Counter Area, Basement
Bldg. 1.1. Issue Request for sale at the
Hospital Bldg.
1.1. Request item to Slip and Issuance
be purchased instruct to pay Counter Area of
at the Issuance at the cashier Linen Section.
Counter Area of located at the
Linen Section, basement of
Basement, MAB Bldg.
Hospital Bldg.

2. Proceed to cashier and get 2. Get Request Slip None Cashier I or

queuing number for and issue Official Cashier II
payment located at the Receipt of Cashier Office
basement of MAB Bldg. payment. Basement, MAB Bldg.
2.1. Instruct
customer to
return to Linen
Section to
claim the item.
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON
PAID RESPONSIBLE

3. Present the Official Receipt 3. Receive Request None 2 minutes Nursing

together with the Request Slip together with Attendant II
Slip at Issuance Counter the Official Receipt Linen Section's, Issuance
Counter Area, Basement
Area of 3.1. Record
Hospital Bldg.
Linen Section, Official Receipt
Basement Number in the
Hospital Bldg. Request Slip.

4. Receive the item together with the 4. claim the item at 2 minutes Nursing
Official Receipt at the Issuance the Issuance Attendant II
Counter Counter Area of Linen Section's, Issuance
Counter Area, Basement
Area of Linen Linen Section,
Hospital Bldg.
Section, Basement, Basement, Hospital Bldg.
Hospital Bldg.
Please see
Total annex for table 8 minutes
of linen fees
End of Transaction
PURCHASE OF LINEN ITEM/S
Guide for all clients on how to avail/purchase linen item/s.

Office/Division: Linen Section

Classification: Simple
Type of Transaction: G2C – Government to Client
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None None
FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
1. Request item/s to be 1. Prepare Charge/ * Please see 2 minutes Nursing Attendant II
purchased at the Issuance Request Slip based Price List of Linen Section's, Issuance Counter
Counter Area of Linen on the request. Linen Items for Area, Basement Hospital Bldg.
Section, Basement Hospital 1.1. Issue Request Sale at the
Bldg. Slip and Issuance
instruct to pay Counter Area of
at the cashier. Linen Section.
2. Proceed and Pay 2. Prepare the None 2 minutes Nursing Attendant II
Applicable Fees at the requested linen Linen Section's, Issuance
Cashier’s office Ground item/s. Counter Area, Basement
Floor lobby or Basement Hospital Bldg.

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE

 PAID TIME
3. Present the Official Receipt 3. Receive Charge/ None 4 minutes Nursing Attendant II
together with the Request Slip Linen Section's, Issuance Counter
Charge/Request Slip and together with the Area, Basement Hospital Bldg.
claim the linen item at the Official Receipt and
Issuance Counter Area of check if payment is
Linen Section, Basement correct.
Hospital Bldg. 3.1. Record
Official Receipt
Number in the
Charge/
Request Slip.
3.2. Issue the
requested
linen item/s
together with
with Official
Receipt
Please see
Total annex for table 8 minutes
of linen fees
End of Transaction
Hospital Support Services
External Services
Admission of Patients - Elective
Admission of patients scheduled for elective procedure once room is available.

Office/Division: Patient Services Division/Admitting Section

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Patients for admission
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Admitting Order Attending Physician/Doctor's Clinic

If patient is under Z-benefit : Z-benefit Coordinator :

- Clinical Pathway 1. Adult - 2nd floor MAB, Surgery and Anesthesia Dept.
2. Pedia - 3rd floor Hospital Building, Pedia Office

If under Surgical Package Deal (SPD) SPD Coordinator - 2nd floor MAB, Surgery and Anesthesia Dept.
- SPD Contract

If Company sponsored/ with HMO: Company, HMO Coordinator/Liason officer

- Guarantee letter

If with Financial Assistance: Social Service Division, Ground floor, Annex Building
- DOH-MAIP
- Service Issue Slip
- PCSO Guarantee letter

If service patient (Elective) Social Service Division, Ground floor, Annex Building
- Clearance for admission (¼ sheet)

If inmate: Bureau of Jail Management and Penology (BJMP)

- Court Order Bureau of Correctional (BuCor)
- Referral letter from BuCor Physician
Official Receipt Cashier's Office, Hospital Lobby

FEES TO PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
BE PAID TIME
1. Present Admitting Orders at 1. Receive Admitting order. None 10 mins. Administrative Assistant or Clerk III
Admitting Counter, Grd. Floor, Hospital 1.1. Assign room Admitting Section
lobby. 1.2 Instruct patient/relative to Ground floor, Hospital Bldg.
fill-out forms.
2. Fill out admitting forms and submit to 2. Receive forms None 10 mins. Administrative Assistant or Clerk III
Admitting counter. 2.1. Check/verify the Admitting Section
accuracy of data. Ground floor, Hospital Bldg.
2.2. Encode data of patient in
the sytem.
2.3. Issue deposit slip and
instruct the patient's relative
to pay required deposit at
Cashier's office.

3. Pay required deposit to Cashier on 3. Receive payment. Applicable 30 mins. Cashier I or Cashier II
duty at Cashier's Office. (Ground floor, 3.1. Issue Official Receipt. fee Cashier's Office, Grd. Flr. Hospital
Hospital Lobby or Basement, Medical Bldg or Basement, Med. Arts Bldg.
Arts Bldg.)

4. Present copy of official receipt to 4. Receive Official Receipt . None 3 hrs. Administrative Assistant or Clerk III
Admitting staff on duty ( Admitting 4.1. Record OR No. in the Admitting Section Ground Floor, Hospital Bldg.
Counter, Grd. Flr. Hospital Lobby) Patient Data Sheet (PDS)
4.2. Issue Admitting Kit,
Philhealth form and Patient
Satisfaction Survey form.
4.3. Instruct patient's relative
to proceed at the Hospital
lobby and wait to be escorted
once room is ready for
admission.

5. Cooperate with Admitting staff during 5. Escort patient to room. None 10 mins. Administrative Aide or Administrative Assistant or Clerk III
escort to room. 5.1. Countercheck patient's Admitting Section, Ground floor, Hospital Bldg.
data and place ID band on the
patient's wrist.
5.2. Endorse patient and
admission documents to the
nurse on duty in the unit.

Total None 4 hrs

End of Transaction
 PHILIPPINE HEART CENTER
East Avenue, Quezon City

HOSPITAL ROOM RATES

AUGUST 1, 2018

UNIT ROOM NOS. OCCUPANCY ROOM RATES

101/104 Single 2 4,500.00

1.Short Stay Unit (SSU) 102/103/105/106 Double 8 2,900.00
108 Quadruple 4 2,900.00
Chemo Room 107 Quadruple P1,050.00 first 3 hours, P290.00/hr in excess of 3 hours
Sleep Study Room 111A-111B Double 2 2,900.00
Emergency Isolation Single 7,000.00
112 Single Room 1 8,300.00**
114-119 Single Room 6 8,300.00**
2.CCU
120-121 Double 4 6,500.00**
122-125 Single 4 8,300.00**
201-210 Single 10 7,500.00
3.SICU 1
211-212 Double 4 5,800.00
215-222/225-228 Single 6 8,300.00**
229-231 Double 6,500.00
4.SICU 2
232 6 beds (A-F) 6,500.00
223/224 Double 6 6,500.00**
5SICU 3 233/235-236 Double 4 6,500.00**
6.3A 300-312 & 314 Single 14 4,500.00
7.3B 315-328 Single 14 4,500.00
329 Double 2 2,900.00
3C 330-332/335-340 Single 3 4,500.00
8.
333-334 Triple 6 2,250.00
Children's Pay ward Bed 1 – 8 Ward 8 1,800.00

341 Isolation room 1 6,000.00

342 & 346 Double/double 4 2,900.00
9.3D
343 & 345 Triple 6 2,250.00
344, 347 – 349 Quadruple 16 1,950.00
350-353/355/357 Double/double 24 2,900.00
10.3E
354/356 Double 4 2,900.00
11.3F 358-364 Double/double 28 2,900.00
Bed 1 -10 Ward 10 4,350.00
12.PICU 1
Isolation room Single 1 4,650.00
13.Adult Pay ward 1 Bed 1 -19 Ward 19 1,800.00
Bed 1 -18 Ward 18 1,800.00
14.Adult Pay ward 2
14.Adult Pay ward 2
Isolation room Isolation room 1 4,200.00
400 A Single 4,500.00 *
400 B Single 2 4,500.00 *
401 A Single 4,500.00 *
401 B Single 4,500.00 *
402 A Single 4,500.00 *
403 Single 5,000.00 *
15.4A 404 Single 5,000.00 *
405 A Single 4,500.00 *
405 B Single 4,500.00 *
406 A Single 4,500.00 *
406 B Single 4,500.00 *
407 A Single 4 4,500.00 *
407 B Single 2 4,500.00*

408-412/414-416
Single 4,500.00
16.4B 419-422 5
417-418 Double 4 2,900.00
438-445 Triple 24 2,900.00
17.4D
437 Isolation room 1 5,200.00
423/427-428/432 Double 2 6,500.00
424-426/429-431 Single 3 8,300.00
18.MICU 1 426 Single-Heal well 9,000.00
433 Isolation room 1 9,000.00
434-436 Single 3 8,300.00
19.MICU 2 Bed A - M Cubicle 13 4,350.00
20.5A 502-507 Single 6 6,000.00
508-512/514-516
Single 5 4,500.00
21.5B 519-522
517-518 Single 2 5,700.00
523-526/529-536 Single 4 4,500.00
22.5C
527-528 Single 2 5,700.00
23.Presidential Suite 1 35,000.00
24.Children's Service Ward 20 beds 20 1,800.00
29 beds 29 1,800.00
25.Female Service Ward
Isolation room 1 bed 1 4,500.00
29 beds 29 1,800.00
26.Male Service Ward
Isolation room 1 bed 1 4,500.00
*Effective February 6, 2019
**Effective March 26, 2019
Retained rooms shall be charged accordingly.
Approved Contract Releasing
This refers to the releasing of approved notarized contract between PHC and Suppliers (Pharmaceutical, Medical Supplies,
Equipment, Services, Preventive Maintenance, Consignment, Food Stuff)

Office/Division: Procurement Division

Classification: Simple
Type of Transaction Government to Business
Who may avail: Supplier
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Authorization Letter Company's Head Office
Company ID Company's Head Office
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Register on the Supplier's 1. Ask the None 2 minutes Administrative Officer II
logbook located near the office representative to
entrance sign in the logbook Procurement Division Office,
Basement, MAB Building
Procurement Division Office,
Basement, MAB Building
2. Go to the staff in charge to 2. Ask for the None 2 minutes Administrative Officer II
receive the approved contract Company ID of the
representative and
the authorization Procurement Division, Basement,
letter MAB Building
3. Receive the approved 3. Give the None 2 minutes Administrative Officer II
contract for notarization approved contract
for notarization Procurement Division, Basement,
MAB Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
3.1 Advise the None Administrative Officer II
authorized
representative to Procurement Division, Basement,
return the original MAB Building
copy of the contract
1 to 2 days once
notarized

3.2 Advise the

authorized
representative to
photocopy the
notarized contract
as supplier's copy
4. Return the notarized 4. Receive the None 2 days Administrative Officer II
contract notarized contract
Procurement Division, Basement,
MAB Building
Total None 2 days

End of Transaction
Art Exhibit
Facilitating different forms of art exhibit display at The Art Gallery

Office/Division: General Services Division

Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who may avail: Visual Artist/ Exhibitor
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Preliminary Requirements
1. Proposal Letter - Client-Initiative
2. Resume of Artist or Group of Artists - Client-Initiative
3. Photos of Artwork/Portfolio - Client-Initiative
Secondary Requirements
1. Notarized Form of Agreement - General Services Division, 2nd Floor, MAB
2. Exhibit Checklist - General Services Division, 2nd Floor, MAB
3. Poster and Mounted Poster* - Client-Initiative
4. Invitations* - Client-Initiative
5. Function Request Form, Sketch plan & set-up - General Services Division, 2nd Floor, MAB
Final Requirements
1. Curator's Time In and Out - General Services Division, 2nd Floor, MAB
2. Sales Report (2 copies) - General Services Division, 2nd Floor, MAB
3. Release Form - General Services Division, 2nd Floor, MAB
4. OR of payment (1 original and 1 photocopy) - Cashier's Office
5. Certificate of Authenticity for donated artwork - General Services Division
FEES TO BE PERSON
CLIENT STEPS AGENCY ACTION PROCESSING TIME
PAID RESPONSIBLE
1. Submit preliminary 1. Receive & review requirements. None 4 minutes Administrative
requirements to the Assistant III
General Services Division 1.1 Forward to PHC Art Gallery
Office Committee (AGC) Chairman for General Services
Division office, 2nd
floor, MAB
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON
PAID RESPONSIBLE

2. Follow-up status of 2. Inform the client of the approval or None 5 minutes PHC AGC Staff
Proposal by calling the disapproval of the request.
General Services Division
at telephone number 2.1 Arrange date of meeting with the
89252401 loc. 3219, or by featured artist and his/her curator. General Services
writing a letter addressed to Division office, 2nd
the Chairman, PHC Art floor, MAB
Gallery Committee.
3. Meet with the Chairman 3. Discuss details with the artist and None 30 minutes PHC AGC
& secure copy of assist in the preparation of the Chairman
Agreement Form with requirements.
checklist
3.1 Issue copy of Agreement form, General Services
Exhibit Checklist and Function Division office, 2nd
Request form. floor, MAB

3.2 Instruct the client to notarize the

Agreement.
4. Submit complete 4. Receive the complete None 10 minutes Administrative
requirements for the exhibit requirements Assistant III / AGC
at GSD Office. Chairman
General Services
Division office, 2nd
floor, MAB
5. Set-up of exhibit 5. Assist on the exhibit set-up None 8 hours Featured Artist,
AGC Chairman &
Housekeeping Staff
General Services
Division office, 2nd
floor, MAB
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON
PAID RESPONSIBLE
6. Open the exhibit. 6. Attend the exhibit None 3 hours PHC AGC &
7. Housekeeping Staff

Ground floor,
Medical Arts
Building Lobby
7. Man the exhibit and 7. Issue blank copy of Curator's None 8 hours Featured artist/
secure final requirements Time -in and out, Sales Report and assigned Curator
form needed in the day to Release Form
day activity of the exhibit. 7.1 Oversee the duration of the Ground floor,
exhibit Medical Arts
Building Lobby
8. Pull-out the exhibit. 8. Supervise the activity. None 3 hours Housekeeping &
Present the Exhibit 8.1 Check the Exhibit Checklist Security Staff
Checklist, Sales Report versus the Sales Report.
and Release Form to the 8.2 Check if the Release Form has Ground floor,
MAB Lobby Guard on duty the approval of the PHC-AGC Medical Arts
upon exit. Chairman Building Lobby
9. List all sold paintings and 9. Verify and check computed sales None 40 minutes Administrative
compute sales and and commission. Assistant III / AGC
commission 9.1 Approve the Sales Report. Chairman / AGC
Members

General Services
Division office, 2nd
floor, MAB
10. Proceed to the Cashier 10. Receive the payment and issue 20% 30 minutes Cashier I
for payment of sold Official Receipt (OR). Commission on
paintings commission if sales Cashier's Office,
applicable. Basement, Medical
Arts Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON
PAID RESPONSIBLE

11. Provide a copy of the 11. File the Sales Report together None 1 minute Administrative
approved Sales report to with the photocopy of the Official Assistant III
the PHC AGC Chairman. report for record purposes.
Give one photocopy of O.R General Services
to the AGC Chairman Division office, 2nd
floor, MAB

20% 3 days
Total Commission on
sales
End of Transaction
Catering Service
Catering service of Cafe 1475 covers around 100 to 150 persons and provides the customers the opportunity to select dish on our cycle menu or
set menu that is appropriate for the event and within their budget.

Office/Division: Cafe 1475

Classification: Complex
Type of Transaction: G2C – Government to Citizen, G2B -Governmnet to Business
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Personal Paid Function Request Form Cafe 1475 Office
Cycle Menu or Set Menu Selection Cafe I475 Office
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Choose preferred 1, Present the cycle menu / set None 15 minutes Foodservice Supervisor I or
dish from the cycle menu. Foodservice Supervisor II
menu or set menu at the
Cafe 1475 Office. 1.1 Instruct client to fill out one(1) Cafe 1475 Office
copy of Personal Paid Function
Request Form
2. Submit the 2.Record the schedule of the None 5 minutes Foodservice Supervisor I or
completely filled out one event. Foodservice Supervisor II
(1) copy of Personal
Paid Function Form at 2.1 Instruct client to pay thefifty
the Cafe 1475 Office. percent (50%) downpayment Cafe 1475 Office
3. Pay the required 3. Receive payment and issue Based on selected 10 minutes Cashier I
downpayment. (must be Official Receipt (OR) menu
5 days before the actual
event) Cafe 1475, Cashier's Area
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Finalize all details two 4. Order all needed ingredients None 10 minutes Foodservice Supervisor III
(2) days before the and prepare the needed dining
event. essentials. Cafe 1475 Office
5. Proceed to the 5. Serve the food and all catering None 4 hours Foodservice Supervisor I or
event's venue amenities as agreed. Foodservice Supervisor II

Cafe 1475 Office

6. Pay the remaining Cashier I
6. Receive payment and issue Based on selected
balance on the day of 10 minutes
Official Receipt (OR). menu
the event. Cafe 1475 Cashier's Area
Based on selected Processing time:
menu 50 minutes
Total
Catering Service:
4 hours
End of Transaction
Certification for Refund to Patient - Pharmacy
The certification is issued to the patient certifying the refund of the amount of unsed/discontinued medicines that are purchased from the
hospital pharmacy.

Office or Division: Pharmacy Annex

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Original copy of Official Receipt (OR) Patient
Purchase Order Slip (POS) PHC Pharmacy
Letter stating the reason of return Licensed Doctor
Authorization letter (if applicable) Patient
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present and submit 1. Receive and validates the None 3 Minute
Pharmacy staff
copies of OR/Invoice and requirements Pharmacy Division
POS

1.1 Issuance of refund claim slip None 1 Minute Pharmacist II

Pharmacy Division
1.2 Prepare the certification for None 5 Minutes Pharmacist IV
refund Pharmacy Division

1.3 Affix the respective None 2 days Pharmacy VI

Pharmacy Division
signatures in the certification by
the Division Chief and Dept Manager
Department Head. Ancillary Services
2. Proceed to releasing 2. Release and issuance of None 1 Minute Pharmacy staff
counter certification for refund Pharmacy Division
TOTAL None 2 days and 10 minutes
End of Transaction
Credit Arrangement
Credit arrangement made in extreme cases where patients/patients' relatives cannot fully settle their hospital bills and doctors'
professional fees.

Office/Division: Treasury
Classification: Simple
Type of Transaction: G2C- Government to Citizen
Who may avail: Patients/patients' relative assessed as with no capacity to pay at the time of discharge.

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Notice of Discharge (1 original) Nurse Station (Hospital Building)

Statement of Account (SOA) (1 original and 1 duplicate) Billing and Claims Division
PF Summary Form (1 original) Billing and Claims Division
Last 3 pages of the SOA – for PF refund (1 original) Billing and Claims Division
Government issued Identification cards ( 2 original ) Concerned government agency

Collateral requirement (original copies) :

If under the name of the person requesting for PN:
Post dated checks (Original) concerned patient/relative
Land title (Original) concerned patient/relative
Vehicle OR/CR (Original) concerned patient/relative

If under the name of other person:

Post dated checks, with photocopy of a valid ID of the person concerned individual
issuing the check (original)
Land title, with SPA authorizing use of title as collateral for PN concerned individual
(all original)
Vehicle OR/CR, with SPA authorizing use of title as collateral for concerned individual
PN (all original)
Vehicle OR/CR, with SPA authorizing use of title as collateral for concerned individual
PN (all original)

FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
1. Submit requirements. 1. Receive the required None 3 minutes Credit Officer III or
documents and check for Cashier III or SAO or CAO
completeness and Treasury Division, Basement
appropriateness. MAB

1.1 Issue request for PN form for

Hospital Bills

2. Fill up Request for Promissory 2. Check data supplied by the None 3 minutes Credit Officer III or
Note (PN) for Hospital bill. patient's representative and Cashier III or SAO or CAO
indicate amount of PN Treasury Division, Basement
MAB
2.1 Issue PN form for
Professional Fee
3. Fill up Request for Promissory 3. Check data supplied by the None 5 minutes Credit Officer III or
Note (PN) for Professional Fees. patient's representative and Cashier III or SAO or CAO
indicate amount of PN Treasury Division, Basement
MAB

4. Proceed to the Deputy 4. Indicate payment arrangement None 15 minutes DED-HSS

Executive Director for Hospital and approve/signs request for PN 2nd floor, MAB
Support Services (DED-HSS) for
approval of request for PN for
Hospital Bill
5. Return to Treasury with the 5. Prepare promissory note None 5 minutes Credit Officer III or
approved request for PN Cashier III or SAO or CAO
Treasury Division, Basement
MAB
6. Proceed to the Doctors clinic 6. Approve/signs request for PN None 30 minutes Concerned Doctors
for approval of request for PN for Doctor's Clinic
professional fees.

FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
7. If doctors are not available, 7. Inform doctors via SMS None 1 hour and 5 Credit Officer III or
proceed to Treasury division. regarding the request for PN minutes Cashier III or SAO or CAO
Treasury division staff will inform Treasury Division, Basement
the doctors through SMS MAB
regarding request for PN.
Doctors are given one(1) hour to
respond.
8. Sign promissory note for 8. Receive signed PN, provide a None 3 minutes Credit Officer III or
Hospital bill and PF copy for the relative. Notes “OK Cashier III or SAO or CAO
for discharge” on patient's notice Treasury Division, Basement
of discharge MAB

9. Proceed to Cashier for final 9. Stamp “Approved Discharge” None 3 minutes Cashier I or Cashier II
approval of notice of discharge and sign Notice of Discharge. Cashier's Office, Basement,
Medical Arts Building

TOTAL None 2 hours and 12

minutes
End of Transaction
 Discharge of Z Benefits Inpatients
The clearance for discharge is issued to Z Benefits in-patients with discharge orders. This clearance is issued to affirm that the
recommended amount of co-pay (if there is any) is paid and settled before the patient is discharged.

Office/Division: Billing and Claims Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Z Benefit Inpatient For Discharge
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Notice of Discharge Form - Nurse Station
(1 copy)
Official Receipts of amount of co-pay - Issued by Cashier’s Office upon payment
If payment is through financial assistance/ insurance:
1. Service Issue Slip - Social Services Division, Main Office PHC Annex Building
2. Health Maintenance Organization (HMO) Letter of - HMO Coordinator
Authorization (LOA)
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1 Secure queuing number at the 1. Prompt queuing number None 30 minutes Administrative Assistant II
machine located at the entrance
of the business center and wait Billing and Claims Division
to be called
2 Present notice of discharge 2 Receive and check amount of None 15 minutes Administrative
and submit Official Receipts of co-pay vis-a-vis official receipts, Assistant II
payment and/or LOA & SIS for LOAs and SIS
the amount of co-pay (if Billing and Claims
applicable) to Billing Staff for 2.1 Issue Order of Payment if co- Division
assessment and verification pay is not yet paid
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3 Pay the required amount of 3 Receive payment and issue As per order of 30 minutes Cashier I
co-pay by showing the Order of Official Receipt (OR) payment
Payment at the Cashier’s Office, Cashier’s Office
Basement Basement

4 Return to Billing counter and 4 Record OR Number in PDS or None 5 minutes Administrative Assistant II
present the Official Receipt (OR) SOA
Billing and Claims Division
4.1 Stamp the Notice of
Discharge with Okay for
Discharge” and sign

4.2 Give instruction to the client to

proceed to the nurse station
where the patient is admitted
Total None 1 hour and 20 minutes
End of Transaction
Discount on Medicines

The Office of the Deputy Executive Director for Hospital Support Services approves
requests for 20% discount on medicine purchase of qualified government employees

OFFICE: Hospital Support Services

CLASSIFICATION: Simple
TYPE OF TRANSACTION: G2C – Government to Citizen
WHO MAY AVAIL: Government Employees and Dependents
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Certificate of Employment (COE) Respective Agency
Office Identification Respective Agency
Prescription Slip Attending Physician
Authorization (if representative) Government Employee
FEES PERSON
CLIENT STEPS AGENCY ACTION TO BE PROCESSING RESPONSIBLE
PAID TIME
1. Present Certificate of 1. Receive requirements
Employment (COE), ID, None 2 minutes Private Secretary II
Prescription Slip(s) and 1.1 Stamp approve for Administrative Officer II
Administrative Aide VI
ID of Representative 20% discount
2. Claim,approved doctor's 2. Give the prescription Private Secretary II
prescription None 2 minutes Administrative Officer II
Administrative Aide VI
Office of the Deputy Executive Director
for Hospital Support Services
2nd Floor, Medical Arts Building
TOTAL None 4 minutes
End of Transaction
* In the absence of COE and Office ID, Unexpired GSIS E-Card maybe presented.
Dispensing of Medicines: In-Patient
Medicines are dispensed to ensure that admitted patients shall receive the right drug, dose, route at the right time.

Office or Division: Main Pharmacy

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request slip (computer generated copy) Requesting PHC staff/unit
Special prescription (S2) Licensed Doctor
Drug Requisition Issue Voucher Requesting unit/ward
Antimicrobial Utilization Form Requesting PHC staff
SS recommendation (if applicable) Social Service Division
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit a prescription 1. Print the request slip for None 1 Minute Pharmacist II
or request slip from processing Pharmacy Division
nurses through the
MedTrak system. 1.1 Validates the patient's None 1 Minute Pharmacist II
category (NBB, Z-Benefit, Pharmacy Division
Credit suspended)
1.2 Checks the drug None 2 Minutes Pharmacist II
availability and execute the Pharmacy Division
order entry.
Pharmacy Aide and/or
1.3 Prepares the medicine None 8 Minutes Pharmacist II
per request. Pharmacy Division

1.4 Records the medicines None 2 Minutes Pharmacy Aide and/or

in the respective bin cards Pharmacist II
Pharmacy Division
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.5 Place the prepared None 4 Minutes Pharmacy Aide and/or
medications in the ward's Pharmacist II
respective trays per request Pharmacy Division
slip.
1.6 Check and dispense None 10 Minutes Pharmacist II
medications to the Pharmacy Division
nurse/NA/NO
per ward
1.7 Place the medications in None 2 Minutes Pharmacist II
the respective box or carts Pharmacy Division
and lock for security
purposes.
TOTAL None 30 Minutes
End of Transactions
Dispensing of Medicines to Out-Patient (Annex Bldg.)

The Dispensing of Medicine to out-patients is to provide and ensure that patients receive the right medicine, right dose, and route at the
right time as prescribed by doctors.

Office or Division: Pharmacy Division (Annex)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Original Prescription/s License Physician
Senior Citizen / PWD ID Office of the Senior Citizen Affair / PWD Office
If Financial Assistance, Service Issue Slip Social Service, Ground Floor, Medical Arts Building Annex
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.Proceed to OPD Pharmacy 1. Issue queueing number on
Pharmacy staff
counter and get queue a first come first serve basis.
None 2 Minutes Pharmacy Division, Ground
number 1.1. Instruct relative to wait for Floor, Annex Bldg.
number to be called
2. Present doctor's 2. Receive and validate
Pharmacist II
prescription and doctor’s prescription and None 2 Minutes
requirements requirements.
2.1 Print and issue Purchase
Order Slip (POS) and instruct Pharmacist II
None 2 Minutes
to pay the amount due

2.2 Prepare the medicines per Admin Aide V

POS None 10 Minutes Pharmacy Division, Annex
Bldg.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Payment of the amount 3. Receive payment and issue
due per POS the Official Receipt Cashier I on duty
3.1 Instruct the payor to claim As indicated on the
30 minutes Treasury Division, Ground
the medicine at Pharmacy POS
counter Floor, Annex Bldg.

4. Present copy of Official 4. Receive official receipt and None 2 minutes Pharmacist II
Receipt (OR) at Pharmacy copy the OR number to POS
Counter, Ground Floor MAB Pharmacy Division, Ground
Annex Floor, Annex Bldg.

5. Receive prescribed 5. Dispense prescribed None 1 minute Pharmacist II

medicines medicines
Pharmacy Division, Ground
Floor, Annex Bldg.

TOTAL: None 49 Minutes

End of Transaction
Dispensing of Medicines to Out-Patient (Satellite)

The Dispensing of Medicine to out-patients is to provide and ensure that patients receive the right medicine, right dose, and route at the
right time as prescribed by doctors.

Office or Division: Pharmacy Satellite - 4th Flr, MAB

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Original Prescription/s License Physician
Senior Citizens / PWD ID Office of the Senior Citizen Affair / PWD Office
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Get a queue number at 1. Issue queueing number on
Pharmacist II
the Pharmacy Counter a first come first serve basis.
None 2 Minutes Pharmacy Division, 4th Flr,
1.1. Instruct relative/patient to
Medical Arts Building
wait for number to be called
2. Present doctor's 2. Receive and validate
Pharmacist II
prescription and doctor’s prescription and None 2 Minutes
requirements at Pharmacy requirements.
Counter 2.1 Print and issue Purchase
Order Slip (POS) and instruct None 2 Minutes Pharmacist II
to pay the amount due
2.2 Prepare the medicines per Admin Aide V
None 10 Minutes
POS
2.3 Receive and validate
doctor’s prescription and Pharmacist II
None
requirements. 2 Minutes Pharmacy Division, 4th Flr,
Medical Arts Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Payment of the amount 3. Receive payment and issue
due per POS at Pharmacy the Official Receipt Cashier I on Duty
Counter 3.1 Instruct the payor to claim As indicated on the
2 Minutes
the medicine at Pharmacy POS Pharmacy Division, 4th Flr,
counter Medical Arts Building

4. Present copy of Official 4. Receive official receipt and None 2 Minutes Pharmacist II
Receipt (OR) at Pharmacy copy OR number to POS
Counter Pharmacy Division, 4th Flr,
Medical Arts Building
5. Receive prescribed 5. Dispense prescribed None 1 minute Pharmacist II
medicines medicines
Pharmacy Division, 4th Flr,
Medical Arts Building
TOTAL: None 23 Minutes
End of Transaction
Dispensing of Medicines to Out-Patient with Service Issue Slip (SIS)

The Dispensing of Medicine to out-patients is to provide and ensure that patients receive the right medicine, right
dose, and route at the right time as prescribed by doctors. Charges are based on the approved/endorsed amount of
medicines in the Service Issue Slip (SIS)

Office or Division: Pharmacy Division (Annex)

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Patient with GL
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Original prescription/s License Physician
Service Issue Slip (SIS) Social Services Division
Authorization letter (if applicable) Patient
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Get a queue number at the 1. Issue queueing number on
Pharmacist II
Pharmacy Counter a first come first serve basis.
None 2 Minutes Pharmacy Division, Ground
1.1. Instruct patient/relative to Floor, Annex Bldg.
wait for number to be called
2. Present doctor's 2. Receive and validate
Pharmacist II
prescription and doctor’s prescription and None 2 Minutes
requirements at the requirements.
Pharmacy Counter 2.1 Print the Purchase Order
Pharmacist II
Slip (POS) None 2 Minutes

2.2 Prepare the medicines per Admin Aide V

POS None 10 Minutes Pharmacy Division, Ground
Floor, Annex Bldg.
Doctor's Clinic (Application for Clinic Space)
Rental of Doctor's Clinic space.

Office/Division: GENERAL SERVICES DIVISION

Classification: G2C – Government to CItizen
Type of Transaction: Simple
Who may avail: Qualified Doctors
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Letter of Intent Client Initiative
Notarized Contract of Lease – 3 original copies General Services Division
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit a Letter of 1. Receive the Letter of Intent None 1 minute Executive
Intent to the Executive 1.1 Forward the approved letter of Director / Deputy
Director thru the the applicant to facilitate the Executive Director for
Deputy Executive contract. Otherwise, D.O will Medical Services,
Director for Medical inform the applicant on the status nd
2 Flr., Medical Arts
Services. of his/her application for clinic Building
space.
See table of fees 1 day Accounting Staff
1.1 Approved Letter of Intent will Accounting Division,
be forwarded to the Accounting Basement,
Division for computation of rental, Medical Arts Building
recording and accounting
purposes.
None 10 minutes Administrative Assistant III
1.2 Preparation of Contract of General Services Division,
Lease (Prepare 3 sets of Contract 2nd Flr, Medical Arts
of Lease for signature of all the Building
doctors/lessees occupying the
clinic including the applicant /new
tenant
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING PERSON RESPONSIBLE
TIME
2. The applicant 2. The signed contract should be None 1 day Chief Admin. Officer,
together with all the returned back to the General Deputy Exec. Director for
doctors occupying the Services Division for signatures of Hospital Support Services
clinic should sign the the General Services Division and
contract. Chief Admin. Officer, Deputy Accounting
Exec. Director for Hospital Division Chief
Support Services and Accounting Admin. Officer
Division Chief Admin.
Officer 2nd flr, Medical Arts
Building
3. Signed Contract of 3. Receive notarized copy of None 30 minutes Administrative Assistant III
Lease should be Contract of Lease to the GSD for General Services Division,
notarized. record and reference purposes. 2nd flr, Medical Arts
3.1 Distribute the notarized Building
contract of lease 1st copy -new
lessee 2nd copy – Accounting
Division 3rd copy- General
Services Division
Total See table of fees 2 days and 41
minutes
End of Transaction
 DOH Financial Assistance
Process by which patient gets financial assistance through DOH Medical Assistance for Indigent Patients (DOH MAIP)

Office/Division: Social Services Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All patient with DOH MAIP Guarantee Letter (GL)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Reference Number / DOH MAIP Guarantee Letter Public Assistance Unit of DOH or Legislator's office

PHC Medical Records 6th Floor Medical Arts Building (MAB), Hospital of
Medical Certificate / Clinical Abstract (1 original, 1 origin, Doctor's clinic
photocopy)
PHC – Social Service

Certificate of Indigency SSS, BIR, GSIS, Pagibig, Post Office, Office of the Senior Citizen Affairs
(OSCA),
Government Issued Identification Card (1 photocopy)

Additional requirements for the following:

Billing Section, Basement of MAB
For hospital bill assistance:
Statement of Account
•
For medicine assistance: Attending Physician
latest prescription including all of the above

For laboratory procedure assistance:

laboratory/ procedure request Attending Physician
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Proceed to Malasakit 1. Receive and check None 5 minutes Clerk III
Center waiting area at completeness of
Annex Building lobby requirements. Malasakit Center waiting
area, Annex lobby
1.1 Present requirements 1.1 Issue DOH MAIP Patient
to clerk on duty form and instruct
patient/relative to completely
fill out the DOH MAIP form
2. Fill-out DOH Maip form 2. Receive and check filled- None 3 minutes Clerk III
completely and endorse to out DOH Maip form
clerk on duty
2.1 Instruct relative to wait for
the release of the approved
Service Issue Slip (SIS)

2.2 Process Guarantee Letter 10 minutes Clerk III

(GL).

2.2.1 Verify from the DOH

system the authenticity of the
GL

2.2.2 Print
Service Issue Slip (SIS)

2.2.3 Endorse to social 2 minutes Clerk III

worker in-charge for review
and signature

2.2.4 Review correctness of 5 minutes Social Welfare Officer II

SIS

2.2.5 Submit to authorized Clerk III

officials for approval of SIS
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
 3. Claim SIS and proceed 3. Release SIS and instruct None 2 minutes Clerk III
to unit for availment of patient/relative to proceed to
service Pharmacy for medicines,
Billing for hospital bill,
Laboratory Medicine for lab
tests, other Income Centers
for procedures
Total None 27 minutes per GL
transaction
End of Transaction
Function Rooms’ Use (Outsider)
This refers to request for utilization of Function Rooms by non-PHC employees.

Office/Division: GENERAL SERVICES DIVISION

Classification: Simple
Type of Transaction: G2C – Government to Citizen G2G- Government to Government G2B-Government to Business
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Executive Director's approved letter for the Use of Function - Client's Initiative
Room
Function Request Form (3 original copies) - General Services Division, 2nd Floor, MAB
Application for the Use of Function Room (2 original copies) - General Services Division, 2nd Floor, MAB
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Call or Inquire at the 1. Confirm the availability of None 3 minutes Administrative Assistant III
General Services Division function room. Administrative Officer I
(GSD) to ask for the General Services Division,
availability of the Function 1.1 Instruct the client to 2nd Flr., MAB
room. write a letter addressed to
(89252401 loc. 3219) the Executive Director for
General Services Division, the approval for the Use of
2nd Floor MAB function room.

1.2 Wait for the approval 1 day

from the Executive Director.

If approved:
1.3 Instruct the client to
proceed to the GSD office
to secure an Application for
the Use of Function Form
and Function Request Form
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. 2. Proceed to the GSD office 2.1 Assess the filled out None 30 minutes Administrative Officer I and
to get and fill out applicable function request form. Chief Administrative
forms. Officer
2.2 Discuss with end-user General Service
the details of the activity Division, 2nd Flr, MAB
and their needs.

If with catering service:

Instruct the client to write a
letter of Ingress/Egress
addressed to the Chief
Administrative Officer, GSD.

If they will use electricity for

the equipments and
instruments they will be
bringing in, an additional
charge for the electricity
consumption will be
imposed.

2.3 Compute
corresponding fee and
approve the Application for
the Use of Function Room
form.

3. Get a queuing number and 3. Receive payment and See table of fees 30 minutes Cashier on duty
pay the corresponding fee at issue Official Receipt (OR). Cashier's Office,
the Cashier's Office. Basement, MAB
4. Submit Official Receipt at 4. Record the OR number. None 5 minutes Administrative Officer III
the General Services General Service
Division (GSD) Division, 2nd Flr, MAB
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
6. Observe the time and date 6. Set up function as None 2 hours Housekeeping Staff (Task
of request. requested prior to the date Force)
and time of usage. General Service
Division, 2nd Flr, MAB
In case of usage extension: 7. Verify availability of See table of fees 5 minutes Chief Administrative
function room for usage Officer,
7. Request for an extension extension. General Service
of the use of paid function Division, 2nd Flr, MAB
room.
8. Return to General 8. Compute the number of See table of fees 5 minutes Administrative Assistant III/
Services Division for the hours extension. Administrative Officer I,
computation of rates for General Service
approved extension of Division, 2nd Flr, MAB
usage.
9. Get a number and pay 9. Receive payment and See table of fees 10 minutes Cashier I on duty
corresponding fees to the issue OR. Cashier's Office,
Cashier's office. Basement, MAB
10. Submit the OR for the 10. Get the O.R number None 2 minutes Administrative Assistant III/
extension fees to GSD. and file necessary Administrative Officer I,
documents for record General Service
purposes. Division, 2nd Flr, MAB
Please see 1 day and 3 hrs.
Total
applicable rates
End of Transaction
Gate Pass for Equipment (PHC Tenants)
Bringing out of equipment and accessories from PHC premises requires Gate Pass.

Office/Division: Property and Supply Management Division

Classification: Simple

Type of Transaction G2B – Government to Business

Who may avail: PHC Tenants

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Control Pass Gate Security Posts
Approved Letter of Request for Gate Pass or Routing General Services Division
Slip
List of Equipment Tenant's Office
Company ID or any valid ID with proof of company Company's Head Office/ Concerned Office
affiliation and authorization
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Secure a Control Pass 1. Issue Control None 5 minutes Security Guard on Post
from the guard at Gate of Pass Gate of Entry
entry and/or approved
Letter of Request for Gate 1.1 Approve Letter None 10 minutes Chief Administrative Officer
Pass or Routing Slip from of Request for Gate General Services Division, 2nd
Tenant's Office Pass or Routing Floor, Medical Arts Building
Slip
2. Submit the Control Pass/ 2. Prepare the Gate None 10 minutes Property Section Staff
approved Request for Gate Pass Property and Supply Management
Pass or Routing Slip and List Division, Basement, Medical Arts
of Equipment to Property and Building
Supply Management Division
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME

3. Present Company ID or any 3. Sign Gate Pass None 5 minutes Chief Administrative Officer
valid ID with proof of company Property and Supply Management
affiliation and authorization Division, Basement, Medical Arts
Building

4. Claim Gate Pass 4. Issue Gate Pass None 1 minute Property Section Staff
Property and Supply Management
Division, Basement, Medical Arts
Building
Total None 31 minutes

End of Transaction
Gate Pass for Equipment (Suppliers)
Bringing out of equipment and accessories from PHC premises requires Gate Pass.

Office/Division: Property & Supply Management Division

Classification: Simple

Type of Transaction G2B – Government to Business

Who may avail: Suppliers - Company/Agency Owners or Representatives

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Control Pass Gate Security Posts
Requests for Gate Pass or its equivalent EMD (for Hospital Equipment), MISD (for I.T. Equipment), End-Users
communication form
Company ID or any valid ID with proof of company Company's Head Office / Concerned Office
affiliation and authorization
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME

1. Secure a Control Pass from 1. Issue Control None 5 minutes Security Guard on Post
the guard at Gate of entry Pass Gate of Entry
for demo/loaner unit:

Secure Request for Gate 1.1 Issue Request

Pass or Routing Slip for for Gate Pass or None 10 minutes EMD staff for Hospital Equipment
repair, rejected delivery, Routing Slip. MISD staff for I.T. Equipment
expired tie up agreement: End-Users' staff for other concerns

Concerned Unit
 AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
CLIENT STEPS
PAID TIME

2. Approve the
2. Submit the Control
Control None 5 minutes Staff of Concerned Unit
Pass/Request for Gate Pass
Pass/Request for Concerned Unit
for approval of Concerned Unit
Gate Pass by
Concerned Unit

3. Present approved Control

Pass and/or Request for Gate 3. Prepare the Gate None 10 minutes Property Section Staff
Pass and other supporting Pass Property and Supply Management
documents to the Property and Division, Basement, Medical Arts
Supply Management Division Building
(PSMD)

4. Present Company ID or any 4. Sign Gate Pass None 5 minutes Chief Administrative Officer
valid ID with proof of company Property and Supply Management
affiliation and authorization. Division, Basement, Medical Arts
Building

5. Claim Gate Pass 5. Issue Gate Pass None 1 minute Property Section Staff
Property and Supply Management
Division, Basement, Medical Arts
Building
Total None 36 minutes

End of Transaction
Gate Pass for Equipment
Bringing out of equipment and accessories from PHC premises requires Gate Pass.

Office/Division: Property & Supply Management Division

Classification: Simple

Type of Transaction G2B – Government to Business

Who may avail: Suppliers - Company/Agency Owners or Representatives

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Control Pass Gate Security Posts
Requests for Gate Pass or its equivalent EMD (for Hospital Equipment), MISD (for I.T. Equipment), End-Users
communication form
Company ID or any valid ID with proof of company Company's Head Office / Concerned Office
affiliation and authorization
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME

1. Secure a Control Pass from 1. Issue Control None 5 minutes Security Guard on Post
the guard at Gate of entry Pass Gate of Entry
for demo/loaner unit:

Secure Request for Gate 1.1 Issue Request

Pass or Routing Slip for for Gate Pass or None 10 minutes EMD staff for Hospital Equipment
repair, rejected delivery, Routing Slip. MISD staff for I.T. Equipment
expired tie up agreement: End-Users' staff for other concerns

Concerned Unit
 AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
CLIENT STEPS
PAID TIME

2. Approve the
2. Submit the Control
Control None 5 minutes Staff of Concerned Unit
Pass/Request for Gate Pass
Pass/Request for Concerned Unit
for approval of Concerned Unit
Gate Pass by
Concerned Unit

3. Present approved Control

Pass and/or Request for Gate 3. Prepare the Gate None 10 minutes Property Section Staff
Pass and other supporting Pass Property and Supply Management
documents to the Property and Division, Basement, Medical Arts
Supply Management Division Building
(PSMD)

4. Present Company ID or any 4. Sign Gate Pass None 5 minutes Chief Administrative Officer
valid ID with proof of company Property and Supply Management
affiliation and authorization. Division, Basement, Medical Arts
Building

5. Claim Gate Pass 5. Issue Gate Pass None 1 minute Property Section Staff
Property and Supply Management
Division, Basement, Medical Arts
Building
Total None 36 minutes

End of Transaction
Gate Pass for Supplies (Suppliers)
This is a gate pass to bring out construction tools, supplies, and medicines from PHC premises.

Office/Division: Property & Supply Management Division

Classification: Simple

Type of Transaction G2B – Government to Business

Who may avail: Suppliers - Company/Agency Owners or Representatives

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Control Pass Gate Security Posts
Requests for Gate Pass or Routing Slip EMD (for tools & materials), MISD (for I.T. accessories), End-Users
(for other concerns)
Company ID or any valid ID with proof of company Company's Head Office / Concerned Office
affiliation and authorization
Proposal for Credit Memo Company's Head Office / Concerned Office
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME

1. Secure a Control Pass from

the guard at Gate of entry

If for demo/loaner unit: 1. Issue Control None 5 minutes Security Guard on Post
Pass Gate of Entry
Secure Request for Gate
Pass or Routing Slip

If for rejected 1.1 Issue Request None 10 minutes EMD staff for construction tools &
delivery, expired tie up for Gate Pass or materials
agreement Routing Slip. MISD staff for I.T. accessories
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME

If for expired medicines 1.2 Request for None 3 minutes End-Users' staff for other concerns
Proposal for Credit
Memo Concerned Unit

2. Approve the
2. Present the Control
Control None 5 minutes Staff of Concerned Unit
Pass/Request for Gate Pass
Pass/Request for Concerned Unit
for approval of Concerned Unit
Gate Pass by
Concerned Unit

3. Submit approved Control

Pass and/or Request for Gate 3. Prepare the Gate None 10 minutes Supply Section Staff
Pass, Proposal for Credit Pass Property and Supply Management
Memo and other supporting Division, Basement, Medical Arts
documents to the Property and Building
Supply Management Division
(PSMD)

4. Present Company ID or any 4. Sign Gate Pass None 5 minutes Chief Administrative Officer
valid ID with proof of company Property and Supply Management
affiliation and authorization. Division, Basement, Medical Arts
Building

5. Claim Gate Pass 5. Issue Gate Pass None 1 minute Supply Section Staff
Property and Supply Management
Division, Basement, Medical Arts
Building
Total None 39 minutes

End of Transaction
Guided-Group-Tour Request (Online)
To visit/tour the hospital to gain insights on cardiac facilities and its services

Office or Division: Office of the Executive Director

Classification: Simple
Type of Transaction: G2B / G2C / G2B
Who may Avail: ALL
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Letter of Intent (LOI) from the client From the client's end
1.1. written in school/company letterhead and duly signed by the
requesting party
1.2.the following must be indicated:
 purpose of the visit
 target date
 target area(s) to be visited
 number of people included in the tour
 must be submitted at least 3 or 4 days prior to target tour
date.
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
1.Submits LOI online 2.Acknowledges receipt of LOI and None 2 minutes Administrative Officer III
([email protected]) checks completeness. (AO III)
2.1. If incomplete, reply client on 2 minutes
Note: Make sure requirements and advise to complete
acknowledgment of receipt and resend accordingly. 2 minutes
2.2.If compliant, download / print LOI
2.3.Stamp “RECEIVED”
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
and affix signature on the downloaded None 20 PDOIII and/or
copy of the letter. minutes AO II
2.4.Endorses received LOI to the Office
of the Executive Director for approval 30 minutes Executive Director (ED)
Executive Director approves/disapproves
LOI
3.Makes a follow up on online 2. Informs the client on approval / None 10 minutes AO II or AO III or PDO III
request after three (3) working disapproval of the LOI
days as advised. Concerned unit e.g. Public
3.1.Personal follow up or 2.1 On approval, directs client to the Relations Officer (PRO),
through telephone call maybe specific concerned unit for facilitation of 5 minutes Nursing Service, Education
done at telephone 8-925 2401 the guided tour. Training and Research
locals 3200/3201
2.2 On disapproval, initially informs client 30 minutes AO III or AO II or PDOIII
on disapproval.

Official PHC reply shall follow. Unit concerned

TOTAL None 1 hr 43 minutes
End of Transaction
Guided-Group-Tour Request (Personal)
To visit/tour the hospital to gain insights on cardiac facilities and its services

Office or Division: Office of the Executive Director

Classification: Simple
Type of Transaction: G2B / G2C / G2G
Who may Avail: ALL
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Letter of Intent (LOI)
1.1. written in school/company letterhead and duly signed by the Client
requesting party
1.2.two (2) copies – one original and one receiving/file copy
1.3.the following must be indicated:
a)purpose of the visit
b)target date
c)target area(s) to be visited
d)number of people included in the tour
2.Must be submitted at least 3 or 4 days prior to target tour date.
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1.Submits LOI personally 2.Receives LOI and checks NONE 10 minutes administrative Officer II (AO II) or
completeness. If complete, Administrative Officer III (AO III)
Note: Make sure to get 2.1. Stamp “RECEIVED” and or
'stamped' receiving/file copy affix signature on the original Project Development Officer III
and receiving copies of the (PDO III)
letter.
a)Retains original copy
b)Returns receiving/file copy
to client 10 minutes
End of Transaction
Hospital Bill Certification (For Discharged Patients)
Certificate of Confinement and detailed Hospitalization Bills

Office/Division: Accounting
Classification: Simple
Type of Transaction G2C – Government to Citizen
Who may avail: Patient / Authorized Representative
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 Valid Identification (ID) Card of Patient Patient

If thru Representative:
 Valid Identification (ID) Card of Patient Patient
 Valid Identification (ID) Card of Representative Authorized Representative
 Letter of Authorization from patient/immediate Patient/Immediate relative
relative

If patient is expired
 Valid Identification (ID) Card of Patient Immediate Relative/Authorized Representative
 Valid Identification (ID) Card of Representative
 Letter of Authorization from immediate relative
 Death Certificate – 1 photocopy
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Request for Certificate of
Hospitalization bills including Validate request None 10 minutes Accountant II
details of payment Accounting Division

Basement , Medical Arts Bldg.

 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
2. Pay the Certification fee Receive payment & P50.00 30 minutes Cashier 1 or 11
issue official receipt Treasury Division

Prepare & release None 15 minutes Accountant II

Certification upon Accounting Division
presentation of
official receipt.
3. Receive Certification None
Total P50.00 55 minutes
End of Transaction
Hospital Bills Payment (In-Patient)
Hospitalization expenses including professional fees (PF) are collected before approval of the release/discharge of the
confined/admitted patient. An Official Receipt (OR) is issued as proof of payment.

Office/Division: Treasury
Classification: Simple
Type of Transaction: G2C- Government to Citizen
Who may avail: In- Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Pay Patients
Notice of Discharge - 1 Original Nurse Station – Hospital Building
Statement of Account (SOA) – 1 original and 1 duplicate Billing and Claims Division
PF Summary Form - 1 Original Billing and Claims Division
Last 3 pages of SOA – For PF refund - 1 Original Billing and Claims Division

Company Sponsored Patients

Notice of Discharge - 1 Original Nurse Station – Hospital Building
SOA - 2 original and 1 duplicate Billing and Claims Division
PF Summary Form - 1 Original Billing and Claims Division
Last 3 pages of the SOA – for PF refund - 1 Original Billing and Claims Division

Service Patients
Notice of Discharge - 1 Original Nurse Station – Hospital Building
Final Social Service recommendation - 1 Original Social Service Division
Hospital Bills Payment (Out-Patient)
Payment for out-patient diagnostic tests before the actual procedure is done unless otherwise stated. An official receipt (OR) is issued as proof of
payment.
Office/Division: Treasury
Classification: Simple
Type of Transaction: G2C- Government to Citizen
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Pay Patients
Charge Slip - 1 original and 1 duplicate Income Center
Proof of Discount, if any:
Senior Citizen I.D Concerned Office of respective Municipality
Person with Disability (PWD) I.D Concerned Office of respective Municipality
Certificate of Employment for Gov't Employee Government Agency where the patient is employed

Service Patients
Charge Slip - 1 original and 1 duplicate Income Center
Doctor's Request for hospital procedures - 1 original and 1 duplicate Concerned Doctor
OPD Card – original Social Service Division – Philippine Heart Center
FEES TO BE PROCESSIN
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID G TIME
1. Get a number from the queuing 1. Pompt/Call the number to be None 30 minutes Self-generated
machine and wait for number to be served Basement, Cashier's Office
called/served.
2. Present requirements and pay 2. Receive the required None 2 minutes Cashier I/Cashier II
applicable fees documents and check for Cashier's Office
completeness
 2.1. Issue OR as proof of Refer to charge 1 minute (Basement Medical Arts Building) or
payment slips presented Satellite Office (Ground Floor, Hospital
building) or Satellite Office (OPD, Annex
Building)

FEES TO BE PROCESSIN
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID G TIME
3. Claim the OR, Charge Slip and Doctor's 2.2. Return to patient, original None 1 minute Cashier I/Cashier II
Request copies of OR, Charge Slip and Cashier's Office
Doctor's Request
TOTAL Refer to charge 34 minutes
slips presented
End of Transaction
Last Salary Processing

The last salary of a separated employee due to retirement and resignation and other reason for separation of service from PHC are
withheld. The said former employee/s must be free from financial liability before their last salary is released. This process is being done
for that purpose.

Office or Division: HUMAN RESOURCE MANAGEMENT DIVISION

Classification: Simple
Type of Transaction: G2C- Government to Citizen
Who may Avail: Resigned/Retired Employee
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Statement of Leave Human Resource Management Division (HRMD)
Application for Leave form (Terminal Pay) HRMD
Service Record HRMD
List of Leave without pay, undertime, tardiness and HRMD
lacking hours (if applicable) HRMD
Latest Daily Time Record(DTR) Resigned/Retired employees
Administrative Clearance Form HRMD
Nursing Services Clearance Form (for Nursing Office of Nursing Services
Employees) HRMD
Release and Quit Claim HRMD
Appointment/Contract HRMD
Statement of Assets, Liabilities and Net worth HRMD
Approved Resignation Letter HRMD
Acceptance of Resignation HRMD
GSIS Clearance Government Service and Insurance System (GSIS)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1 Submit all 1.1 Receive and check the None 15 mins HRM Assistant / Clerk III
Requirements completeness of requirements HRMD
to the HRMD
1.2 Review and Prepare Statement None 1 day HRM Assistant / Clerk III
of Leave.& Service Record and HRMD
submit to Payroll Section.

1.3.Compute the last salary and None 1 day HRM Assistant/

other benefits based on his/her Clerk IV
entitlement HRMD

1.4 Prepare & submit the None 15 mins HRM Assistant / Clerk III
computation to Accounting for HRMD
pre audit.
1.5 Audit Computation base on None 1 day Accountant III
submitted documents and return Accounting Division
back to HRMD-Payroll
1.6 Preparation of Disbursement None 15 mins Chief Administrative Officer,
voucher forward to Budget Budget Division
Division for Budget Utilization for
approval
1.7 Accounting Division sign
Disbursement Voucher None 1 day Chief Accountant
Accounting Division
1.8 Accounting Division submit to
Cashier’s Office for preparation None 4 hours Cash Clerk III
Of check Cashier’s Office
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1.9 Forward to office of Hospital Deputy Executive Director for
Support Services and Executive None 2 days Hospital Support Services
Director for signature of check Executive Director

2. Receive check 2. Release Check for Last Salary None 15 mins. Cash Clerk III
for last salary Cashier’s Office
Basement, MAB

TOTAL None 6 days and 5 hrs

mins,
End of Transaction
Medical Representative's ID
This is the Identification Card issued to Medical Representatives which shall serve as a gate pass, renewable every year and must be
displayed at all times while inside the PHC.

Office/Division: GENERAL SERVICES DIVISION

Classification: Simple
Type of Transaction: G2B-Government to Business
Who may avail: Medical Representatives
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Application Form - General Services Division, 2nd Floor, MAB
Original Certificate of Employment written on the - Client Initiative
Company's official Letterhead – indicate - Client Initiative
medicine/product offered at PHC
ID picture 1x1 - 2 pcs

Mondays/Wednesdays (1:00-3:00pm) -Issuance of ID

Tuesdays/Thursdays (1:00-3:00pm) - Application
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Get application 1. Instruct the client to fill out None 5 minutes Administrative
form at General the form and attached the Assistant III
Services Division necessary requirements. General Services Division,
(GSD) office 2nd Floor, 2nd Flr., MAB
MAB
2. Submit the filled-out 2. Review the completeness of None 5 minutes Administrative
Application form with documents received. Assistant III
attached required Chief Administrative Officer
documents 2.1 Forward Application form to General Service
the Chief Administrative Officer Division, 2nd Flr, MAB
for approval.

Be sure to advise the client to

pay necessary fees at the
cashier.
3. Pay applicable fees 3. Receive payment and issue 200.00 30 minutes Cashier on duty
Official Receipt (OR). Cashier's Office, Basement,
MAB
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Submit Official 4. Acknowledge the receipt and None 1 day Administrative
Receipt at the General advise the client to come back Assistant III, Chief
Services Division on the Issuance days which are Administrative
(GSD) Mondays and Wednesdays at Officer and Executive
1:00-3:00pm. Director
4.1 Prepare the Medical General Service
Representative’s ID. Encode Division, 2nd Flr, MAB
the name, company name, Office of the Executive
4.2 The Chief Administrative Director , 2nd Floor MAB
Officer will make an initial on
the name of the Executive
Director.
4.3 General Services Division
will Forward the Medical
Representatives ID to the
Office of Executive Director for
the signature of the Executive
Director.
5. Acknowledge 5. Release the Medical None 5 minutes Administrative Assistant III
receipt of Medical Representative’s ID. and Chief Administrative
Representative’s ID. 5.1 Forward Acknowledgement Officer
form to the Chief Administrative General Service
Officer for signature. Division, 2nd Flr, MAB
6. Display the ID at all 6. Check that all Medical None Security Sentinel
times during Representatives doing their General Service
coverage. coverage at the Philippine Division, 2nd Flr, MAB
Heart Center has a valid and
unexpired ID.
Total PHP 200.00 1 day and 45 minutes
End of Transaction
Medication Counseling by the Clinical Pharmacist
To provide information and counsel patients for discharge from the hospital of the medications they will be taken at home as
prescribed by the physician/doctor.

Office or Division: Main Pharmacy

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Patient Discharge Instruction Form or Patient Handbook Ward/Unit
Patient's medical chart Ward/Unit
Medication Counseling Logbook Pharmacy
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Discharge order from 1. Get and review the list of None 2 Minutes Pharmacist III
the attending doctor patients possible for discharge Pharmacy Division
daily.
1.2 The Pharmacist shall proceed None 5 Minutes Pharmacist III
to the unit for review of home Pharmacy Division
medication orders from the chart.
2. The patient shall make 2. The pharmacist shall conduct None 10 Minutes Pharmacist III
himself available for the counseling on medications to be Pharmacy Division
counseling by a taken at home by the patient.
pharmacist. 2.1 The pharmacist shall None 1 Minute Pharmacist III
accomplish the interdisciplinary Pharmacy Division
progress notes.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2.2 The pharmacist shall record the
Pharmacist III
patient medications in the None 2 Minutes
Pharmacy Division
Medication Counseling Logbook
3. The patient shall sign 3. The pharmacist shall
in the medication acknowledge the receipt of the Pharmacist III
None 1 Minute
counseling logbook of counseling to the patient. Pharmacy Division
the pharmacist.
TOTAL None 21 Minutes
End of Transaction
NUTRITION COUNSELING FOR OUT-PATIENTS
Nutrition Counseling provides individualized nutritional care for encouraging the modification of eating habits and assists in the
prevention or treatment of nutrition-related illnesses.

Office/Division: Nutrition and Dietetics Division

Classification: Simple
Type of Transaction: G2C
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Doctor's Diet Prescription (1 Original) Doctor's Clinic for Private Patient or OPD Clinic for Service Patient.
Latest Blood Chemistry (1 Photocopy) Laboratory Medicine Division or Accredited Private Laboratory.
OPD Card – For Service Patients (Original) Social Service Division
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON
RESPONSIBLE
1. Present Doctor's Diet 1. Receive the required None 5 minutes Registered Nutritionist-
Prescription and latest blood documents Dietitian
chemistry at the Nutrition 1.1 Check for (9am-6pm Duty)
Clinic, Nutrition and Dietetics completeness.
Division (NDD). Nutrition and Dietetics
1.2 Inform patient the cost Division,
of Nutrition Counseling. Hospital Building

1.3 Give applicable forms

and instruct to fill out.
2. Submit filled out forms to 2. Received filled out None 3 minutes Registered Nutritionist-
Registered Nutritionist- applicable forms. Dietitian
Dietitian at NDD. (9am-6pm Duty)
2.1 Issue the Order of Nutrition and Dietetics
Payment. Division, Hospital Buidling
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON
Schedule of Nutrition Counseling for Out-Patient
Monday to Friday
10:00am to 4:00pm
 PCSO (Philippine Charity Sweepstake Office) Assistance Availment
Process which patient gets financial support through PCSO. Patient relative undergo interview for assessment to determine amount of
assistance.

Office/Division: Social Services Division

Classification: Simple
Type of Transaction G2C – Government to Citizen
Who may avail: Clients/Patients with cardiac and Non-Cardiac Diseases, Admitted or Non-Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Letter of request of patient/immediate relative addressed to the  To be prepared by patient/immediate relative
Chairman of PCSO (1 original)

Clinical Abstract/ Medical Certificate with license # Physician (1  Attending Physician

original)

Government Issued Identification Card of patient and immediate  SSS, BIR, GSIS, Pagibig, Post Office, Office of the Senior
relative ( 1 photocopy) Citizen Affairs (OSCA)

For hospital bill assistance:

Latest Statement of Account/Hospital Bill (1 original copy)  PHC Billing Section Basement of Medical Arts Building

For Diagnostic Procedures assistance:

Request, Quotation (1 original copy) and result of previous  Attending Physician and PHC Diagnostic Center
dignostic test (1 xerox copy)

For chemo drugs assistance:

Prescription, Treatment Protocol, Quotation of Drugs (1 original  PHC Oncologist and PHC Pharmacy Basement of Medical Arts Building
copy) and Histopath result (1 xerox copy)

For dialysis assistance:  Attending Physician and PHC Billing Section Basement of Medical Arts
Certificate of on-going dialysis, Philhealth certification of exhausted Building, Philhealth office
coverage (1 original)
 Company/supplier of implant
For implants assistance:
3 Price quotations of implants (1 original), result of diagnostic test
(1 photocopy)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Get queuing number and 1. Receive and screen all None 1 minute Administrative Aide IV
submit requirements document SSD Transaction Area
indicated in the checklist at
Social Service Main Office,
Ground Floor Annex Building

2.Report for interview 2. Request patient/ None 20 minutes Social Welfare Officer -
immediate relative to fill out SSD PCSO Desk
PCSO IMAP Application
Form.

2.1. Counter Check/confirm None 2 minutes Social Welfare Officer -

data: indicate point score SSD PCSO Desk
using PCSO classification
system.

2.3. Issue follow up slip to None 5 minutes Social Welfare Officer -

patient/ immediate relative SSD PCSO Desk
and instruct to call at 4pm for
those interviewed before 12
noon or follow up at 4pm the
following day for those
interviewed beyond 12 noon

2.4. Encoding of filled-out None 5 minutes Administrative Aide IV

PCSO IMAP Application SSD Transaction Area
Form.

2.5 Preparation of None 2 minutes Administrative Aide IV

transmittal. SSD Transaction Area
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2.5.1. Submit encoded None 2 minutes Administrative Aide IV
PCSO IMAP Application SSD Transaction Area
From and transmittal for
review and signature of
social worker and chief.
Administrative Aide IV
2.5.2 Scan all PCSO None 5 minutes SSD Transaction Area
requirements and transmittal.

Administrative Aide IV
2.6 Send scan copy of None 1 minute SSD Transaction Area
requirements to PCSO (Lung
Center of the Philippines
Compound) for approval.
Administrative Aide IV
2.7. Check and print emailed None 3 minutes SSD Transaction Area
transmittal by PCSO of
approved cases
Administrative Aide IV
2.8 Send to Billing and None 3 minutes SSD Transaction Area
Treasury Division the
approved transmittal via
email

3. Follow up status of 3. Inform immediate relative None 1 minute Administrative Aide IV

approval of request of the approved amount SSD Transaction Area

3.1 For In-Patient: If patient

is already for discharge,
instruct immediate relative
to proceed to Billing to
facilitate discharge of patient
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
For OPD cases: Advise
patient to report to SSD after
three (3) working days from
date of approval to get
documents and will be
advised to proceed to PCSO
Lung Center of the
Philippines to claim
Guarantee Letter

Total None 50 minutes

End of Transaction
Price Certification Issuance
Price Quotation and/or certification (Cardiac/Chemo Drugs) is issued to patients requesting for prices of medicines to be used in availing
medical assistance thru Guarantee Letter (GL) at Malasakit Center and Local Government Units.
Office or Division: Pharmacy Division
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Patient
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Original prescription/s License Physician
Original Clinical/Medical Abstract Clinic/Hospital
Request letter/slip from the sponsor Office of the sponsor
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.Proceed to Pharmacy Main 1. Receive and check None 3 Minute Admin Asst II or Pharmacist II
Office, Basement Medical requirements for validation.
Arts Building Annex and None 5 Minutes Admin Asst II or Pharmacist II
1.1 Prepare the certification of
present requirements price quotation.
1.2 Certification of price Pharmacist VI
None 2 Days Pharmacy Division,
quotation for signature of
Basement, Hosptal Bldg.
Pharmacy Division Chief and
Department Head Ancillary Department Manager
Service. Ancillary Services,
2nd Flr, Medical Arts Bldg.
2. Proceed to releasing 2. Release of certification None 1 Minute Admin Asst II or Pharmacist II
counter at Pharmacy Pharmacy Division,
Division Basement, Hosptal Bldg.
TOTAL: None 2 Days 9 Minutes
End of Transaction
Psychological Assessment for Applicants
The psychological assessment is conducted to applicants for available positions within the institution as part of the initial
screening process.

Office or Division: Human Resource Management Division

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: All Qualified Applicants
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Attendance Human Resource Management Division
Payment Slip Human Resource Management Division
FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS
PAID TIME RESPONSIBLE
1. Report on the scheduled 1. Provide attendance None 3 minutes Human Resource
exam and sign the sheet Management (HRM)
attendance sheet at the Assistant
Human Resource HRMD
Management Division
(HRMD)

1.1 Brief the test takers None 10 Minutes Human Resource

Management (HRM)
Assistant
HRMD
2. Undergo Psychological 2. Conduct Psychological None 3 hours HRM Assistant
Assessment Assessment HRMD

2.2 Issue payment slip and None 3 minutes HRM Assistant

instruct to pay HRMD
applicable fees
 FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS
PAID TIME RESPONSIBLE
3. Pay required fee at the 3. Accept payment PHP 150 15 minutes Cashier I
Treasury Division Treasury Division
4. Present official receipt to 4. Record official receipt None 5 minutes HRM Assistant
HRMD number HRMD

3 hours, 36
TOTAL: PHP 150
minutes
End of Transaction
Purchase Order (PO) /Job Order(JO) /Amendment

Issuance of Approved Purchase Order (PO)/Job Order (JO)/Amendment to concerned suppliers for the delivery of goods and
services within the prescribed period.

Office/Division: Procurement Division

Classification: Simple

Type of Transaction Government to Business

Who may avail: Suppliers

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Authorization Letter Company's Head Office
Company ID Company's Head Office
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Sign in the logbook located 1. Ask the None 1 minute Buyer III / Buyer IV/ Administrative
near the entrance representative to Officer II/ Administrative Officer III
sign in the logbook
Procurement Division Office,
Procurement Division Office, Basement, Medical Arts Building
Basement, Medical Arts
Building
2. Go to the respective Buyer/ 2. Check required None 5 minutes Buyer III / Buyer IV/ Administrative
Canvasser to receive the documents Officer II/ Administrative Officer III
approved PO/JO/ Amendment
2.1 Ask the supplier
to acknowledge the
PO/JO/Amendment Procurement Division, Basement,
Medical Arts Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
2.2 Check the
PO/JO/
Amendment if
properly
acknowledged
3. Receive copy of the PO/JO/ 3. Give the None 5 minutes
Amendment supplier's copy of Buyer III / Buyer IV/ Administrative
the PO/JO/ Officer II/ Administrative Officer III
Amendment

Procurement Division, Basement,

Medical Arts Building
Total None 11 minutes

End of Transaction
RECRUITMENT, APPOINTMENT, COMPENSATION
Employment at the Philippine Heart Center is open to all qualified men and women according to the principle of merit and fitness.
There shall be equal employment opportunity for all personnel including person with disability at all levels of position provided that
the applicants meet the minimum Qualification Standards set by the Civil Service Commission for the desired position.

Vacancies are posted at the PHC Website and other bulletin boards situated within the agency premises. Likewise, are published
at the CSC Website for a minimum of ten (10) calendar days.
Office or Division: Human Resource Management Division (HRMD)
Classification: Highly Technical
Type of Transaction: G2C – Government to Citizen
Who may avail: All Qualified Filipino Citizens
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Application Letter indicating the position title &/or item number Concerned Applicant
(if applicable) of the position being applied for (1 original copy)

2x2 ID Picture (1 original copy – White background)

Concerned Applicant
Personal Data Sheet (1 original copy) HRMD; may be downloaded at www.csc.gov.ph

Transcript of Records - with Summary of Related Learning College/University Registrar’s Office where Applicant
Experience for Staff Nurse applicants only (1 photocopy) Graduated

Certificate of General Weighted Average (1 photocopy) College/University Registrar’s Office where Applicant
Graduated
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Authenticated Board Rating, if the position does not require Professional Regulation Commission – Records Section
CSC Eligibility (1 original copy and 1 photocopy)

Latest SPMS – Individual Performance Form (1 photocopy) Concerned Division/Unit; HRMD – Training and Development
Section

Authenticated PRC License, if the position does not require Professional Regulation Commission – Registration Division
CSC Eligibility (1 original copy, 1 photocopy)

Authenticated Civil Service Eligibility, if the position does not Civil Service Commission – Examination Services Division
require PRC License/Board Rating (1 original copy and 1
photocopy)

Oath of Office (2 original copies) Concerned Division/Unit; HRMD – Recruitment Appointment

& Compensation Section (RACS)

Certificate of Employment (1 photocopy) Present or Previous Employer – HR Office / Records Section

Certificate of Training (1 photocopy per training/seminar Present or Previous Employer – HR Office / Training &
attended) Development Section or Records Section

Membership Cards or Certificates (1 photocopy per Concerned Organizations/Associations

membership)

Testing Fee Concerned Applicant

Position Description Form (1 original copy) Concerned Division/Unit; HRMD – RACS

Pag-ibig online membership form (1 original copy) Pag-ibig Office

 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
If employed:
Upon Assumption to Duty form (1original copy) Division/Unit where he/she will be assigned

Certification of Assumption to Duty (1 original copy) HRMD – RACS ; www.csc.gov.ph

Physical Examination with Drug Test Result (1 carbon copy) Infirmary Office

Q.C Health Sanitary Permit (1 photocopy, back to back) Q.C Health Department

NBI Clearance (1 original copy) National Bureau of Investigation

Statement of Assets & Liabilities (2 original copies) HRMD; may be downloaded at www.csc.gov.ph

BIR Form 1902 (2 original copies) HRMD; may be downloaded at

www.bir.gov.ph

BIR Form 2316, if previously employed (1 photocopy) Present or Previous Employer – HR Office

Personal Information Record for Mutual Assistance Benefit HRMD – RACS

Plan (1 original copy)

Handwriting Specimen Card (1 original copy) HRMD – RACS

PHC Payroll Information System Form (1 original copy) HRMD – RACS

1X1 ID Picture (4 original copies – White background) Concerned Applicant

 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Marriage Contract, if applicable (2 photocopies of PSA Copy) Philippine Statistics Authority

Service Record if currently part-time with other Government Other Employer of Concerned Applicant
Agency (1 photocopy)

Phil health Membership Form (1 original copy) HRMD – RACS ; Phil Health Office

Certificate of Office Clearance, if previously employed from Present or Previous Employer – HR Office
other Government Agencies (1 photocopy)

Service Record, if previously employed from other Government Present or Previous Employer – HR Office
Agencies (1 photocopy)

Development Bank of the Philippines Form (1 original copy) HRMD – RACS ; Development Bank of the Philippines

Daily Time Record (DTR) Division/Unit where he/she will be assigned

FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
1. Check posting of 1. Publish Vacant Positions to None 5 minutes HRM Staff-in-Charge
vacancies at www.csc.gov.ph or HRMD / Recruitment Appointment
www.csc.gov.ph or www.phc.gov.ph & Compensation Section (RACS)
www.phc.gov.ph
2. Submit application 2. Received and check application None 5 minutes HRM Staff-in-Charge
letter specifying the letter with complete HRMD / RACS
position desired requirements and issue PHC
together with the Application Form
complete
requirements
 FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
2.1 Accomplish 2.1 Receive accomplished PHC None 3 minutes HRM Staff-in-Charge
PHC Application Application Form HRMD / RACS
Form
3. Undergo preliminary 3. Conduct initial screening and/or None 15 minutes HRM Staff-in-Charge
interview interview of the applicant HRMD / RACS
4. Undergo Examination 4. Facilitate the conduct of None 4 hours HRM Staff-in-Charge
Examination HRMD / Training & Development
Section
4.1 Pay Applicable 4.1 Receive Payment PHP 10 minutes Cashier
Fees at the 150.00 Cashier’s Office
Treasury Division
5. Wait for the referral of 5. Endorse application papers to None 1 day HRM Staff-in-Charge
the screening from the concerned Unit/s HRMD / RACS
End-User
5.1 Notify applicant thru SMS
of the schedule for interview of None 5 minutes HRM Staff-in-Charge
the End-User HRMD / RACS

5.2 Conduct screening of

applicant and schedule for None 1 day HRM Staff-in-Charge
On-the-Job Training HRMD / RACS

6. Undergo On-the-Job 6. Conduct of Training and if None 7 days Department Head Office of
Training found acceptable by the End- Concerned Department Head
User they will prepare
recommendation letter for Deputy Executive Director (DED)
Office of Concerned DED
approval of Executive Director
Executive Director
Office of the Executive Director
 FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
7. Undergo panel 7. If approved, notify the applicant None 1 day HRM Staff-in-Charge
Interview for the schedule of the HRMD / Recruitment Appointment
Deliberation by the Selection & Compensation Section (RACS)
Board

7.1 Prepare result of the None 2 days HRM Staff-in-Charge

Deliberation for signature of HRMD / RACS
the Human Resource Merit Human Resource Merit Promotion
Promotion and Selection and Selection Board
Board (HRMPSB)

7.2 Notify applicant about the None 10 minutes HRM Staff-in-Charge

result HRMD / RACS

8. Await notice of result of 8. Process Appointment and None 1 day HRM Staff-in-charge HRMD /
the Deliberation Certification of Assumption to RACS
Duty

9. Wait for the approval of 9. For approval of HRMPSB and None 1 day Chairperson of HRMPSB
the appointment Executive Director Office of the Chairperson

Executive Director
Office of the Executive Director

10. Acknowledge 10.Issue copy of approved None 10 minutes HRM Staff-in-charge HRMD /
Appointment appointment RACS
 FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
11. Submit Daily Time 11. Verify/Check/Prepare : None 20 minutes HRM Staff-in-charge HRMD /
Record (DTR) RACS
Advice for Initial Salary and
Adjustment (AISA)

11.1Check/Review/Endorse None 10 minutes HRM Supervisor-in-Charge

AISA HRMD / RACS
12 Wait for the release of 12.Review the completeness of None 15 minutes HRM Assistant/Clerk IV
salary requirements for process HRMD/RACS
12.1 Compute the initial & None 2 days HRM Assistant
salary adjustment.
12.2 Prepare and submit
Journal Summary for initial &
adjustment of employees to HRMD/RACS
Accounting for pre audit.

12.3 Audit Computation base None 1 day Accountant III

on submitted documents and Accounting Division, Basement,
return back to HRMD-Payroll Medical Arts Bldg.
12.4 Prepare final List of None HRMO II
Journal Summary to submit to 4 hrs
Accounting.
12.5 Prepare debit memo
12.6 Prepare Budget
HRMO I/HRM Assistant
Utilization Slip None 1 hr
Human Resource Management
Prepare Prooflist and . Division
Soft copy
 FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
12.7 Preparation of Journal None 4 hrs Accountant III
Voucher Summary Accounting Division
forward to Budget
Division for Budget Chief Administrative Officer
Budget Division
Utilization for approval
12.8 Return to Accounting for Chief Accountant
Signature of the Journal None 4 hrs Accounting Division
Voucher.
12.9 Forward to office
Of Hospital Support None 2 days Deputy Executive Director for
Services & Executive Hospital Support Services,
Director for signature of Executive Director
Debit memo

13. Receive the salary 13. Accounting Division to forward

thru DBP automatic the debit memo at None 2 hrs Accountant III
teller machine(atm) or Development Bank of the Accounting Division, Basement,
over the counter DBP Philippines (DBP) for the Medical Arts Bldg.
release of the salary of the
employee.

TOTAL: PHP 21 days, 3

150.00 hours and 48
minutes

End of Transaction
 Refund of Deposit to Service In-Patients
Process by which money deposited is returned to client in the form of check for No Balance Billing (NBB) cases, and elective cases
whose procedures were not performed due to medical reason.

Office/Division: Social Services Division

Classification: Complex
Type of Transaction: G2C Government to Citizen
Who may avail: Philhealth NBB patients, elective cases whose procedure was not done due to medical reason.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Personal letter address to Dr Joel M. Abanilla,  To be submitted by patient or immediate relative
Executive Director (1 original, 1 photocopy)

Official Receipt, (1 original, 1 photocopy)  Cashiers Office, basement of Medical Arts Building (MAB)

Statement of Account from Billing Section signed by  Billing Section, Basement of MAB
the Billing supervisor (1 original, 1 photocopy)

Death certificate for expired patient and marriage  To be submitted by patient or immediate relative
contract (1 photocopy)

• Birth Certificate (if pedia patient)  To be submitted by patient or immediate relative

• (1 photocopy)

if deferred procedure or surgery:

• Letter from the Doctor stating reason  Adult/Pedia fellow
procedure/surgery was deferred (1 original, 1
photocopy)

if NBB:
Philhealth Member Data Record (MDR) (1 original, 1  Philhealth office nearest patient's residence
photocopy)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Get queuing 1. Receive and check None 1 minute Administrative Aide VI

number and submit completeness of documents
required documents
for refund at Social 1.2 Queue required documents None 1 minute SSD Transaction Area
Service Main Office, to social worker in-charge
Ground Flr, MAB
Annex Bldg.
2. Report for interview 2. Interview client None 10 minutes Social Welfare Officer
of social worker in I/II
charge
2.1 Endorse patient's record None 1 minute Social Welfare Officer
to Clerk for preparation of I/II
request for refund

2.2 Issue appointment slip to None 1 minute Social Welfare Assistant

client for follow-up through
telephone

2.3 Submit request for refund None 1 day Social Welfare Assistant
to Chief of SSD for signature
and for edorsement to
Director's Office for approval.

2.4Endorse approved None 1 day Senior Bookkeeper

request for refund to Accounting Division
Accounting Division for
preparation of voucher

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
 2.5 Endorse voucher to None 1 day Cash Clerk III
Cashier's Office for cheque Cashier's Office
preparation.

2.6 Submit voucher and 3 days Cash Clerk III

check to approving authority Cashier's Office
for signature

3. Claim check at 3. Release check None 5 minutes Cash Clerk III

Cashier basement of Cashier's Office
Medical Arts Building
Total None 6 days and 19 minutes
End of Transaction
Refund of Excess Deposits / Cancelled Out Patient Procedures ( more than P15,000.00 )

Excess deposit as reflected in the final Statement of Account upon discharge is refunded to the patient or his representative.

Office/Division: Treasury
Classification: Complex
Type of Transaction: G2C- Government to Citizen
Who may avail: All Out-Patient

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Excess Deposits
SOA, with attachment ( SIS, SC/PWD/ ID, Cert of Employment) (1
original, 1 photocopy) Billing and Claims Division
Filled up Request for Refund (1 original) Treasury Division
Identification card of patient or relative/representative (1 photocopy) concerned patient/relative/representative
Authorization letter from patient, if necessary (1 original) concerned patient

Cancelled Out Patient Procedure

Certification of cancelled procedure from Income Center (1 original) concerned Income Center
Charge Slip (1 original) concerned Income Center
Proof of Payment (Official Receipt -1 original) concerned patient/relative/representative
Filled up Request for Refund (1 original) Treasury Division
Identification card of patient or relative/representative (1 photocopy) concerned patient/relative/representative
Authorization letter from patient, if necessary (1 original) concerned patient

FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
1. Get a number from the 1. Prompt/Call the number to be None 30 minutes Cashier I or Cashier II
queuing machine and wait for served Cashier's Office, Basement,
number to be called/served at Medical Arts Building
Cashier's Office, Basement,
MAB.
2. Proceed to counter and 2. Receive the required None 3 minutes Cashier I or Cashier II
present requirements documents and check for Cashier's Office, Basement,
completeness Medical Arts Building

3. Fill up request for refund form 3. Receive filled up form and None 2 minutes Cashier I or Cashier II
attach the same to the other Cashier's Office, Basement,
required documents. Medical Arts Building

3.1. Forward to Accounting None 2 minutes Cashier I or Cashier II

Division for audit/processing and Cashier's Office, Basement,
preparation of Disbursement Medical Arts Building
voucher.(DV)
3.2. Accounting Division to None 3 working days Accounting Division
forward approved DV to Treasury
Division for Check preparation
3.3. Treasury Division prepares None 1 working day Clerk IV or Credit Officer I
Check and check voucher. Cashier's Office (Basement,
Forwards DV and check to Medical Arts Building)
Finance Services Department for
approval
3.4. Finance Services None 1 working day Finance Services
Department to DED – HSS for Department
signature of check

FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
 3.5. DED-HSS to DED-Medical None 1 working day Office of the DED-HSS
Services (up to P50,000.00) or
Director's Office (more than
P50,000.00) for signature of
check.

3.6. DED-Medical Services or None 5 minutes DO or Office of the DED-

DO to forward signed check and Medical Services
DV to Treasury Division
3.7. Treasury Division logs check None 1 minute Cash Clerk III or Clerk IV
in the Warrant Register Cashier's Office (Basement,
Medical Arts Building)
4. Acknowledge receipt of check 3.8. Release check to patient or None 1 minute Cash Clerk III or Clerk IV
by signing in the Warrant authorized representative. Cashier's Office (Basement,
Register Medical Arts Building)

TOTAL None 6 days and 44

minutes
End of Transaction
REFUND OF EXCESS PAYMENT ON HOSPITAL BILLS
Refund of excess payment due to financial assistance.

Office/Division: Accounting Division

Classification: Complex
Type of Transaction Government to Citizen
Who may avail: Patients with refund of excess payments
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Photocopy of voucher and official receipt from PCSO Treasury Division

Photocopy of hospital bills and Service Issue Slip Patient or Accounting Division
(if applicable).

Patient's valid Identification (ID) Card. Patient

ADDITIONAL REQUIREMENTS:

If filed through a representative:

 Authorization letter Patient
 Valid Identification (ID) card of authorized Authorized representative
representative.

If patient is a minor, photocopy of birth certificate. Patient’s relative

If patient is expired :
 Marriage certificate and valid Identification Patient's spouse
(ID) card of patient and spouse, if with
surviving spouse.
 Death Certificate of patient
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
 If both patient and surviving spouse are
already expired.
 Notarized waiver /affidavit of children to Patient's children
whom the refund will be paid.
 Submission of valid Identification (ID) card
of patient and children.
 Birth certificate of children.
 If claimant is a sibling (patient has no child) Patient's sibling
 Special power of attorney

If Service Patient:
 Social Service recommendation for refund
of excess payment
Accounting Division
Refund request form
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Present required 1. Verify from the None 3 minutes Senior Bookkeeper
documents at Accounting patient/representative if pay Accounting Division
Division Counter. or service patient. Basement, Medical Arts
Building
2. Submit requirements and 2. Receive/ validate all the None 5 minutes Senior Bookkeeper
fill up refund request form at necessary documents
Accounting Division Counter.
2.2. Prepare Disbursement
voucher and forward to the None 3 days Senior Bookkeeper
Treasury Division for check
preparation and advice for
follow- up. Accounting Division
Basement, Medical Arts
2.3 Advise Building
patient/representative on
date of follow-up.
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
2.4 Prepare Disbursement None Senior Bookkeeper
Voucher and forward to Chief, Accountant
chief Accountant for
signature of Box C

2.5 Forward Disbursement None Senior Bookkeeper

to Treasury Division for Accounting
preparation of Check

2.6 Advise None

patient/representative on
date of follow-up

2.7 Forward Disbursement None 3 days Cash Clerk/Clerk IV

Voucher and check to Treasury Division
following offices for
signature
- Department Manager III,
Finance Service
- Deputy Executive Director
for Hospital Support
Services
- Deputy Executive Director
for Medical
Services/Executive Director
3. Acknowledge the receipt of 3. Release the check None 2 minutes Cash Clerk III or Clerk IV
check at Cashier's Office Cashier's Office
Basement, Medical Arts
Building
None 6 days and 10
Total
minutes
End of Transaction
Refund of PhilHealth Benefits
In-Patients and Out-patients with excess Philhealth Benefit
Office/Division: Accounting Division
Classification: Complex
Type of Transaction G2C - Government to Citizen
Who may avail: Patient with Philhealth Benefits (In-Patient/Out-Patient)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Copy of Auto Credit Payment of Notice Form Accounting Division
Copy of Patient Account Ledger/Hospital Bill Billing and Claims Division or Accounting Division
Philhealth Benefit Eligibility Form (PBEF) Billing and Claims Division
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Request for refund of 1. Prepare Disbursement Voucher None 10 minutes Administrative Assistant VI
Philhealth Benefits at the (DV) Accounting Division,
Accounting Division.

1.1. Forward DV to Billing and None 3 minutes Administrative Assistant VI Chief

Claims Division for verification at Administrative Officer,
Philhealth portal and generation of Billing and Claims Division
PBEF

1.2 Forward to Chief of Billing and None 3 minutes Administrative Assistant VI

Claims Division and Chief Chief of Billing and Claims
Accountant for signature of Box A Division, Chief Accountant
and C

1.3 Forward to Treasury for Check None 3 days Cash Clerk III
Preparation and signature Cashier’s Office/Chief
Of Dept. Manager III, Deputy Administrative Officer, Treasury
Director for Hospital Support Division
Services, Deputy Executive Director Department Manager III, Deputy
for Medical Services and Executive Executive Director for Hospital
Director Support Services, Deputy
Executive Director for Medical
Services
Releasing of Checks to Suppliers and Contractors
Release of checks prepared in payment for procured goods and/or services to authorized representative of supplies/contractors.

Office/Division: Treasury
Classification: Simple
Type of Transaction: G2B- Government to Business
Who may avail: Company Collectors or Authorized Representatives
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Collection or Official Receipt (OR) – 1 original per check Concerned company
Company ID – 1 original Concerned company
FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
1. Proceed to the Check 1. Validate requirements and None 2 minutes Cash Clerk III or Clerk IV
Releasing counter and present pull out disbursement voucher. Cashier's Office Basement,
requirements Medical Arts Building
2. Fill up and sign appropriate 2. Validate data supplied by the None 4 minutes Cash Clerk III or Clerk IV
boxes of the disbursement supplier's representative in the Cashier's Office Basement,
voucher disbursement voucher. Medical Arts Building
3. Issue a Collection or Official 3. Check collection or OR None 3 minute Cash Clerk III or Clerk IV
Receipt issued. Cashier's Office Basement,
Medical Arts Building
4. Acknowledge receipt of check 4. Release check payment None 1 minute Cash Clerk III or Clerk IV
by signing in the Check Cashier's Office Basement,
Releasing Logbook 4.1 Assist representative in Medical Arts Building
signing the Check Releasing
Logbook.
TOTAL None 10 minutes
End of Transaction
Request for Approval – Guarantee Letter(s) - (GLs)
Approval on GLs from Legislators are done prior to the processing of Service Issue Slip (SIS)
by the Accounting Division. The SIS is presented to various income centers of the hospital to avail of
free hospital procedures

Office or Division: Office of the Executive Director

Classification: G2C
Type of Transaction: Simple
Who may Avail: Those issued with Guarantee Letters (GLs) for assistance
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Original Guarantee Letter(s) (GLs) Office of the Senators with Trust Fund at PHC

Office of the City/Provincial/Local Government

with Trust Fund at PHC
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
2 Administrative Officer II or
1. Presents original copy of the GL(s) 1. Checks original GL(s) NONE minutes Project Development Officer III
2. Receives approved original copy of 2. Secures signature of the 5 Administrative Officer II or
GL(s) Executive Director NONE minutes Project Development Officer III
2.1 Hands in approved original
GL(s) to clients 2 Administrative Officer II or
2.2 Retains copy of GLs NONE minutes Project Development Officer III
9
Total : NONE minutes
End of Transaction
Request for Approval – Inter Agency Networking Referral Services (Referral from PHC)
Requests emanate from PHC to other government hospital to avail of discounted rates on procedures not available at PHC to help augment
expenses of service/indigents patients.

Office or Division: Office of the Executive Director

Classification: Simple
Type of Transaction: G2G
Who may Avail: Referrals from Government Hospitals
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Letter from PHC referring service inpatients to other government PHC Social Service Division
hospital to avail of procedure not available with recommendation from
PHC Social Service Division
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1.Presents requirement No. 1 2.Hand in presented referral 2
letter, checks completeness. If minutes Administrative Officer II or
complete, receives referral Project Development Officer III or
letter for signature of the Administrative Officer III
Executive Director
NONE
2.1.Endorse referral letter to
the Office of the Executive 2
Director minutes

1.2. Approval of the Executive

Director
1.3 Secure signature of 30
Executive Director
alternate signatory if the NONE minutes
Executive Director is not
available
End of Transaction
Request for Approval – Inter Agency Networking Referral Services (Referral to PHC)
Referrals emanate from government hospitals to avail of discounted rates on procedures available at PHC to help augment
expenses of service/indigents patients.

Office or Division: Office of the Executive Director

Classification: Simple
Type of Transaction: G2G
Who may Avail: Referrals from Government Hospitals
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Letter from referring government hospital with the following From the referring hospital
attachments:
1.1.procedure request PHC Income Centers e.g Laboratory Medicine, CT MRI Laboratory
1.2.price quotation of the procedure(s) PHC Social Service Division
1.3.Discounted rate of the procedure(s)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1.Presents 1 (1.1 to 1.3) 2.Hands in presented referral 2
letter, checks completeness minutes
Administrative Officer II or
2.1.If incomplete, advise client
Project Development Officer III or
to complete requirements
Administrative Officer III
2.2.If complete, receives 5
referral letter for approval of NONE minutes
the Executive Director
2.3.Endorses referral letter to
the Office of the Executive 2
Director minutes

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE

PAID TIME
1.4 Approval of the Executive NONE 30
Director minutes
End of Transaction
Request for Discretionary Discount
This discount is extended on top of the mandatory discounts. The Executive Director or his authorized Officer-in-Charge give this kind of
discount on their discretion.

Office or Division: Office of the Executive Director

Classification: Simple
Type of Transaction: G2C
Who may Avail: ALL (Inpatients excluding service patients and surgical package deal admissions)
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Copy of the FINAL hospital bill Billing Section
1.1.signed by the billing staff
1.2.all mandatory discounts applied
1.3.all other benefits/outsourced assistance reflected
1.4.outstanding hospital bill amount
2.Copy of the Clinical Abstract. Hospital unit where patient is admitted (done by the Fellow-on-duty)
3.Copy of identification card(s) (IDs) of the requesting client(s)
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
1.Presents copy of FINAL hospital bill 1.Checks completeness of NONE 20
(HB) presented final hospital bill, as to: minutes
Note: 1.1.Total payment(s) made;
1.2.Mandated discounts applied;
and
1.3.Other benefits given to
include all financial assistance Administrative Officer (AO)
extended / outsourced III
1.4.Makes a written briefing for
the Executive Director using 10
Discount Request / Slip minutes
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
1.5.Form (FM-OED-2019-003) 2
1.6.Attaches Nos. 2 ad 3 of the minutes
requirements to the HB
1.7.Forwards the discount 30 AO III
request to the Office of the minutes
Executive Director with all the
requirements attached for
notation of discounts.
Notation of discount, if any by the 45 Executive Director
Executive Director minutes
2. Follows up on submitted request 2. Returns/Hands in to the client NONE
the presented documents with
the written discretionary 3
discount, if any. minutes AO III
3. Receives all documents presented
with the written discretionary discounts, 3. Retains file copy of discount 2
if any slip form NONE minutes AO III
Total : NONE 1 hr 54 minutes
End of Transaction
Request for Financial Assistance (FA)
This is usually requested by patients/patients' relative to seek financial assistance for hospital bills, hospital procedures and surgeries.
Patients are referred to PHC Social Service for further evaluation and outsourcing of funds.
Office or Division: Office of the Executive Director
Classification: Simple
Type of Transaction: G2C, G2G
Who may Avail: Basically in and outpatients with cardiac and cardiac-related diseases
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1.Letter request and/or referral/endorsement letter Personal letter or letter from referring/endorsing hospital / agency
2.Request(s) for laboratory procedure(s) and/or final hospital bill, if Attending Physician / Billing Section
admitted Nursing Unit where patient is admitted
3.Clinical Abstract or any a medical records available. Originating municipality
4.Social Case Study
5.Copy of Patient's ID
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1.Presents letter request and/or 2.Screen and check NONE Executive Assistant V
referral/endorsement letter completeness of requirements:
2.1. Detail on the financial
background of the patient 45
2.2.Advise patient to minutes
outsource all possible
assistance e.g DOH MAIP,
PCSO, DSWD, Legislators'
Fund, PAGCOR and Malasakit
Center Fund
2.3.Mandated benefits –
Philhealth, Senior Citizen and
PWD discounts 30
2.4.Refer patient to PHC minutes
Social Service Division using
FM-OED-2019-005 for further
 evaluation and assessment

CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE

PAID TIME
3.Receives back the request (with the 2. Retain copy of all NONE 10 EA V
attachments) presented with slip (FM- documents given to the client minutes
OED-2019-005); proceed to the Social
Service Division as instructed.
Total : NONE 1 hr and 15
minutes
End of Transaction
Resigned/Retired Employees’ Benefits

This benefit is being released for resigned/retired employees such as Midyear and Year-end bonus, Monetization, Performance Based-
Bonus(PBB) & Collective Negotiation Agency (CNA) Incentive

Office/Division: Human Resource Management Division

Classification: Complex
Type of Transaction: G2C-Government to Citizen
Who may avail: All resigned/retired PHC employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Approval of the Release Human Resource Management Division (HRMD)
Letter of Request Resigned/retired employees
Signed clearance form Human Resource Management Division
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
1.Submit request 1. Receive letter of Request. None 30 minutes HRMO II, HRM Assistant/
Letter to HRMD 1.1 Prepare and send Clerk IV
endorsement letter to the Human Resource
office of Hospital Support Management Division
Service and Executive
Director for approval.
1.2 Prepare Disbursement 2 days HRM Assistant/Clerk IV
Voucher (DV) & Budget Human Resource
Utilization slip and submit Management Division
to Accounting Division
Pre Audit. 1 day Chief Administrative Officer
1.3 Forward to Budget Budget Division
Division for Budget
Utilization Chief Accountant
1.4 Return to Accounting for 4 hours Accounting Division
signature of DV
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON RESPONSIBLE
PAID
1.5 Accounting submit to Accountant III
Cashier’ Office for check None 4 hours Accounting Division
preparation
1.6 Forward to office of Hospital Deputy Executive Director for
Support Services & Executive 1 day Hospital Support Services
Director for signature of check Executive Director
2.Receive Check 2. Release Check for Benefit None 1 day Cash Clerk III
for Benefit Cashier’s Office, Basement,
MAB

Total None 6 days and 5 mins

End of Transaction
Service Issue Slip (SIS) Issuance
Patient with original Guarantee Letter of Priority Development Assistance Fund (PDAF) and City / Provincial Government Fund will
receive or avail Service Issue Slip as financial assistance.

Office/Division: Accounting
Classification: Simple
Type of Transaction G2C – Government to Citizen
Who may avail: Patient with PDAF Guarantee Letter
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Original Guarantee Letter (PDAF) and City / Provincial Legislator's Office
Government Fund.
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present Original 1. Receive and verify
Guarantee Letter from authenticity of Guarantee None 5 minutes Accounting Clerk /
various Legislators Letter and availability of Supervisor
(PDAF). funds.
2. Wait while the request 2. Prepare Service Issue None 10 minutes Accounting Clerk /
is being processed. Slip (SIS). Supervisor
3. Fill-up the necessary 3. Record in the logbook
information in the logbook for control purposes. None 1 minute Accounting Clerk /
and receive service issue Supervisor
slip. 3.1 Advise patient /
patient’s representative to
present Service Issue
Slip to Income center /
Billing & Claims Division
for the necessary service.
Total None 16 minutes
End of Transaction
Social Service Assistance (Out-Patient)
Process by which patient/relative undergoes interview/psychosocial intervention for appropriate service classification.
Office/Division: Social Services Division
Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All indigent/poor patients with cardiac and other cardiac related diseases
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

New Out-Patient
Philhealth Member Data Record ( 1 original, 1 photocopy) Philhealth office nearest patient's residence

Patient's picture 1 whole body, one 1x1 Patient

If employed:
Latest 1 month pay slip (1 original, 1 photocopy) Employer

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.Get queuing number at 1. Advice relative/watcher to
Social Service Main wait for number to be called None 1 minute Administrative Aide VI
Office, Ground Floor at designated windows SSD Transaction Area
Annex Building (Window 2 for Priority
numbers e.g. SC, PWD,
pregnant; and at Window 3
for Regular numbers)
1.1 Submit Financial 1 minute Administrative Aide VI
Assistance (FA) form at 1.1 Call patient by number, for None SSD Transaction Area
designated window privacy reasons; receive FA
form and advice
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
relative/watcher to wait for
his/her turn for interview by
Social Welfare Officer (SWO).

1.2 Queue FA form at

None 1 minute Administrative Aide VI
assigned SWO’s room
SSD Transaction Area
2. Enter to MSW's room 2.Conduct interview and None 30 minutes Administrative Aide VI
psychosocial assessment SSD Transaction Area
using MSWD Patient
Assessment Tool and make
progress notes of the case.
3. Report to In-Patient 3. Conduct discharge None 5 minutes Social Welfare Officer I/ II
social worker in-charge planning
for interview
3.1 Prepare necessary None 10 minutes Social Welfare Officer I/ II
referrals to Fund Sources
from both Government &
Non-Government agencies

3.2 Prepare SS None 15 minutes

Recommendation and submit Social Welfare Officer I/ II
to supervisor/ Chief, SSD for
approval

3.3 Review and approve SS None 3 minutes

recommendation Social Welfare Officer I/ II

3.4 Issue SS None 5 minutes

Recommendation and Social Welfare Officer I/ II
Philhealth transmittal form to SSD Transaction Area
relative/watcher
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Claim Social Service 4. Advise relative/watcher to None 2 minutes Social Welfare Officer I/ II
Recommendation and proceed to Billing section to SSD Transaction Area
Philhealth transmittal facilitate discharge
form
4.1Instruct relative/watcher to None 2 minutes Social Welfare Officer I/ II
submit to Billing section SSD Transaction Area
Philhealth transmittal form to
receive Philhealth pertinent
documents and return to
social service and ensure
that Billing, Cashier,
Pharmacy & Bloodbank have
stamped in the Notice of
Discharge
5. Submit accomplished 5. Receive accomplished None 1 minute Administrative Aide VI
Philhealth transmittal Philhealth transmittal form SSD Transaction Area
form to SSD and instruct relative/watcher
to present the fully signed
notice of discharge to nurse-
in-charge

Total None 45 minutes

End of Transactions
 Social Service Assistance - In-Patient

Process by which patient/relative undergo interview/psychosocial intervention for

appropriate service assistance as in-patient.
Office/Division: Social Services Division
Classification: Simple
Type of Transaction: G2C-Government to Citizen
Who may avail: All indigent/poor patients with cardiac and other cardiac related diseases
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
New In-Patient
Philhealth Member Data Record ( 1 Philhealth office nearest patient's residence
original, 1 photocopy)
Local Government Unit Department of Social Welfare & Development at place of
Social Case Study Report (1 original, residence
1 photocopy)
Nearest photobooth
Patient's picture (1 whole body, 1 1x1)

if employed:
Employer
Latest 1 month payslip (1 original, 1 photocopy)

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.Get queuing number at 1. Advise relative/watcher to None 1 minute Administrative Aide VI
Social Service Main wait for number to be called SSD Transaction Area
Office, Ground Floor at designated windows
Annex Building (Window 2 for Priority
numbers e.g. SC, PWD,
pregnant; and at Window 3
for Regular numbers)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.1 Submit Financial 1.1 Call patient by number, None 1 minute Administrative Aide VI
Assistance (FA) form at for privacy reasons; receive SSD Transaction Area
designated window FA form and advise
relative/watcher to wait for
his/her turn for interview by
Social Welfare Officer
(SWO).

1.2 Queue FA form at

assigned SWO’s room None 1 minute Administrative Aide VI
SSD Transaction Area

2. Enter to MSW’s room 2. Conduct interview and None 30 minutes Social Welfare Officer I/II
once called psychosocial assessment
using MSWD Patient
Assessment Tool and make
progress notes of the case.

2.1 Classify patient None 3 minutes

according to the Social Welfare Officer I/II
implementing guidelines of
Department of Health and
explain the equivalent
assistance the patient could
avail

2.2 Advise patient/relative to None 2 minutes Social Welfare Officer I/II

read, understand and sign in
the Contract of
Responsibility for Service
Patients

2.3 Explain and issue None 3 minutes Social Welfare Officer I/II
checklist of SSD
 requirements.

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2.4 If patient’s Philhealth is None 5 minutes Social Welfare Officer I/II
inactive or Philhealth PBEF
portal show expired LGU
Sponsorship, enroll patient
as Point Of Service-
Financially Incapable (POS-
FI) then issue Routing Slip to
concerned units to inform
patient’s classification of No
Balance Billing (NBB)

2.5 For non-NBB patients, None 3 minutes

arrange counterpart/share Social Welfare Officer I/II
for this confinement based
on SSD classification of D,
C3, C2, C1 or B.

2.6 Provide appropriate

instructions to None 2 minutes Social Welfare Officer I/II
relative/watcher and
coordinate inital evaluation
to medical team

2.7 Submit fully

accomplished MSWD Patient Social Welfare Officer I/II
Assessment Tool to None 2 minutes
supervisor for approval SSD Chief/
Supervisor

Total None 53 minutes

End of Transaction
 Social Service Assistance at Emergency Room
Process by which patient relative undergoes interview/psychosocial intervention for appropriate service classification and other support
services.

Office/Division: Social Services Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: All indigent/poor patient with cardiac and other cardiac related diseases
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Philhealth Member Data Record ( 1 original copy, 1 Philhealth office nearest patient's residence
photocopy)
• Social Case Study Report (1 original) Local Government Unit Department of Social Welfare & Development at
• place of residence

Patient's picture (1 whole body and 1 1x1) Nearest photobooth

•
If employed:
Latest 1 month payslip (1 original, 1 photocopy) Employer

If for discharge:
Philhealth documents like CSF, CF4, MDR and Photocopy CSF at Billing Section basement of Medical Arts Building (MAB), CF4 and
of lab test – if NBB photocopy of lab test at ER charge nurse

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Submit filled -out 1. Receive filled-out PDS None 1 minute Social Welfare Officer I/
Patient Data Sheet (PDS) and instruct relative to wait for SWO II
form at Social Service number to be called for ER SSD Office Basement
Division (SSD) office interview MAB
basement of MAB
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Report for 2. Conduct interview/using
interview/psychosocial MSWD Patient None 30 minutes Social Welfare Officer
assessment Assessment Tool I/SWO II
  ER SSD Office Basement
MAB

2.1 Classify patient according None 5 minutes Social Welfare Officer

to socio economic condition I/SWO II
and psycho social status and ER SSD Office Basement
issue SSD checklist of MAB
requirements and issue
Temporary Social Service
Card

2.2 Advise relative/watcher to None 1 minute Social Welfare Officer

report at OPD for check up I/SWO II
as scheduled ER SSD Office Basement
MAB

Total None 37 minutes

End of Transaction
Statement of Account (OPD Dialysis Patients with Philhealth Benefit)
The Billing and Claims Division prepares Statement of Account for outpatient dialysis patients availing Philhealth benefit. One Billing and
Claims Division staff is assigned to prepare the Statement of Account at the Renal and Metabolic Division as an added service to the
patients.

Office/Division: Billing and Claims Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Outpatient Dialysis Patients Availing Philhealth Benefits
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
With Philhealth Claim:
For Employed Member:
1. Claim Signature Form (CSF) - Renal and Metabolic Division
2. Certificate of Philhealth Contribution - Member
3. CF4 - Renal and Metabolic Division

For Individually Paying member:

1. Claim Signature Form (CSF) - Renal and Metabolic Division
2. Proof of Payment / Certificate of Contribution - Member / Philhealth Office
3. CF4 - Renal and Metabolic Division

For Senior Citizen or Retiree:

1. Claim Signature Form (CSF) - Renal and Metabolic Division
2. Member Data Record (MDR) or Philhealth Lifetime - Member
Member ID
3. CF4 - Renal and Metabolic Division
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
For Indigent Sponsored Member: - Renal and Metabolic Division
1. Claim Signature Form (CSF) - Member / Philhealth Office
2. Member Data Record (MDR) or original CE1 Form - Renal and Metabolic Division
3. CF4
Discount for Senior Citizen or PWD Patient:
• Senior Citizen’s ID (1 photocopy) or PWD Card (1 - Patient
photocopy)

Discount for Government Employee Patient:

• Original Certificate of Employment - Employer

Discount for Dependent of Government

Employee:
• Original Certificate of Employment of the principal with - Employer
indicated dependents

*Only immediate members of the government employee are

entitled to discount:
For married employees
– spouse and children below 21 years old
For single employees
– parents only
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1 Submit the required 1 Receive the required documents None 10 minutes Administrative Assistant II
documents to the Billing and check for completeness /
staff assigned at Renal appropriateness Billing and Claims Division
Division before the
procedure 1.1 Deduct the corresponding
Philhealth benefit and applicable
discount, if any from the patient’s
bill

1.2 Print Statement of Account

2 Acknowledge and 2 Assist the client in the None 5 minutes Administrative
receive the Statement of acknowledgment of the Statement Assistant II
Account by filling up of Account
necessary data: Billing and Claims
2.1 Release Statement of Account Division
• Printed name of
patient and 2.1 Inform the Clerk III of the Renal
signature / Division that the Statement of
representative Account is already received by
• Contact number the patient’s relative or
• Relationship to representative
patient
• Date signed 2.2 Give instruction to the relative
or patient’s representative to
proceed to Cashier’s Office for
payment or settlement of the
hospital bill
Total None 15 minutes
End of Transaction
Statement of Account (Pay and Company Sponsored In patients)
The service is to provide Statement of Account to all pay and company sponsored patients with discharge orders. The Statement of Account
contains all the hospital charges to be settled or paid by the patient for the services rendered by the hospital and the doctor/s.

Office/Division: Billing and Claims Division

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Pay and Company Sponsored Inpatients For Discharge
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Notice of Discharge Form - Nurse Station where the patient is admitted
( 1 copy)
With Philhealth Claim:
For Employed Member:
1. Claim Signature Form (CSF) - Admitting Section or Billing and Claims Division
2. Certificate of Philhealth Contribution - Employer
3. CF4 & Laboratory results - Nurse Station
(1 photocopy for each result)

For Individually Paying Member:

1. Claim Signature Form (CSF) - Admitting Section or Billing and Claims Division
2. Proof of payment / Certificate of Contribution - Member / Philhealth Office
3. CF4 & Laboratory results - Nurse Station
(1 photocopy for each result)

For Senior Citizen or Retiree:

1. Claim Signature Form (CSF) - Admitting Section or Billing and Claims Division
2. Member Data Record (MDR) or Philhealth Lifetime - Member / Philhealth Office
Member ID
3. CF4 & Laboratory results
(1 photocopy for each result) - Nurse Station
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
For Indigent Sponsored Member:
1. Claim Signature Form (CSF)
2. Member Data Record (MDR) or original CE1 Form - Admitting Section or Billing and Claims Division
3. CF4 & Laboratory results - Member / Philhealth Office
(1 photocopy for each result)
- Nurse Station
If applicable:
• Operating and anaesthesia record
(1 photocopy each) - Nurse Station
• Interventional form for angiogram,
ct angiogram, angioplasty, etc. - Nurse Station
(1 photocopy)
• RFA report (1 photocopy)
- Nurse Station

Discount for Senior Citizen or PWD Patient:

• Senior Citizen’s ID (1 photocopy) or PWD Card (1 - Patient
photocopy)

Discount for Government Employee Patient: - Employer

• Original Certificate of Employment

Discount for Dependent of Government - Employer

Employee:
• Original Certificate of Employment of the principal
with indicated dependents

*Only immediate members of the government employee are

entitled to discount:
For married employees
– spouse and children below 21 years old
For single employees
– parents only
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
If Patient is Company Sponsored:
Letter of Authorization (LOA) or - Patient’s Sponsor or HMO Coordinator
Guarantee Letter (1 original copy)
If payment is through financial assistance:
Service Issue Slip (SIS) - Social Services Division

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Secure queuing 1. Prompt queuing number None 30 minutes Administrative
number at the machine Assistant II
located at the entrance of
the business center and Billing & Claims
wait to be called Division

2. Present notice of 2. Receive and verify None 30 minutes Administrative

discharge and submit completeness / Assistant II and
required documents to appropriateness of Administrative
Billing Staff for assessment requirements submitted Assistant III
and verification
2.1 Forward documents to Billing and Claims
discharger Division

2.2 Discharger compute

applicable discount, PHIC
benefit and HMO coverage
and print the Statement of
Account
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Acknowledge the 3. Assist the relative or None 5 minutes Administrative
Statement of Account by patient’s representative in the Assistant II
filling up necessary data: acknowledgement of
Statement of Account Billing and Claims
1) Printed name and Division
signature of patient’s 3.1 Issue the Statement of
representative Account
2) Contact number
3) Relationship to patient 3.2 Give instruction to the
4) Date signed relative or patient’s
representative to proceed to
Cashier’s Office for payment
or settlement of the hospital
bill
1 hour and 5
Total None
minutes
End of Transaction
Student Affiliation (On-The-Job Training and Work Immersion)

A service that facilitates the communications between students and end-users to ensure a meaningful learning
experience and achieve academic success of Student Affiliates

Office or Division: Human Resource Management Division

Classification: Simple
Type of Transaction: G2C – Government to Citizen
G2B – Government to Business
Who may avail: Senior High School and College Students
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Endorsement Letter from School/ University (1 original
School/ University of the Student
copy)
School/ University of the Student or Human Resource
Acceptance Form if required by the school
Management Division (HRMD)
Memorandum of Agreement (MOA) Human Resource Management Division
Student Affiliate Application Form Human Resource Management Division
ID Picture with White Background (1 2x2, 1 1x1) To be provided by the Student
Affiliation Fee and ID Fee Original Receipt (OR) Cashier’s Office
Student Affiliates’ Request for Certification Form Human Resource Management Division
Daily Accomplishment Report Form Human Resource Management Division
Bundy Card Human Resource Management Division
PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID
TIME RESPONSIBLE
1. Inquire about the 1. Inform the student about None 5 Minutes Human
availability of student the availability of Resource
affiliation slot at HRMD affiliation slot Management
(personal or thru phone (HRM) Assistant
call) HRMD Office,
8th Flr, MAB
 PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID
TIME RESPONSIBLE
2. Proceed to HRMD 2. Give application form to None 15 Minutes HRM Assistant
once slot is ensured student
and fill-out application
form 2.1 Brief the student about None 15 Minutes HRM Assistant
the requirements such HRMD Office,
as 8th Flr, MAB
• Affiliation Fee
• ID Picture
• MOA Template
• Endorsement Letter
Acceptance Form, if needed
3. Wait for orientation 3. Call divisions when None 5 Minutes HRM Assistant
schedule thru text student will report for
message On-the-Job Training
(OJT)/ Work Immersion
HRM Assistant
3.1 Message student for None 20 Minutes HRMD Office,
schedule of orientation 8th Flr, MAB
4. Report on the 4. Provide attendance None 1 Hour and 30 HRM Assistant
scheduled date of sheet and conduct Minutes
orientation and sign on orientation
the attendance sheet at PHP 30 (ID) 5 Minutes HRM Assistant
HRMD 4.1 Give Bundy Card, Daily PHP 5/Hour (Specialty
Accomplishment Report Courses and Work
Form, and Payment Slip Immersion)
for ID and Affiliation Fee PHP 2/Hour (Admin
Courses)

4.2 Deploy students to HRM Assistant

respective divisions None 30 Minutes HRMD Office,
8th Flr, MAB
 PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID
TIME RESPONSIBLE
4.3 Prepare IDs None 1 Day HRM Assistant
HRMD Office,
8th Flr, MAB
5. Claim ID and present 5. Release Student’s ID None 5 minutes HRM Assistant
OR at HRMD and get OR HRMD Office,
8th Flr, MAB
6. Request for certification 6. Give form for None 10 minutes HRM Assistant
once required training certification, check
hours have been requirements, and
rendered and present inform student when to
the following claim the certificate
requirements:
• Compiled Daily
Accomplishment
Report 6.1 Prepare certificate of None 1 Day HRM Assistant
• Bundy Cards completion HRMD Office,
• OR 8th Flr, MAB
7. Claim certificate of 7. Release certificate and None 5 Minutes HRM Assistant
completion at HRMD sign on the receiving HRMD Office,
copy 8th Flr, MAB
Admin Courses: 2 days, 3
TOTAL: No. of training hours hours and 25
rendered x PHP 2 + PHP minutes
30

Specialty Courses:
No. of training hours
rendered x PHP 5 + PHP
30
End of Transaction
Suppliers’ Certificate
Issuance of Certificate of Satisfactory Performance to suppliers upon written request.

Office/Division: Property and Supply Management Division

Classification: Simple

Type of Transaction G2B – Government to Business

Who may avail: Suppliers - Company/Agency Owners or Representatives

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Letter of Request Company's Head Office / Concerned Office
PHC Official Receipt Cashier's Office
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME

1. Submit Letter of Request to1. Receive Letter of None 5 minutes Administrative Assistant III
Property and Supply Request Property and Supply Management
Management Division (PSMD) 1. Division, Basement, Medical Arts
1.1 Issue Order of None 5 minutes Building
Payment

1.2 Instruct to pay None 10 minutes

applicable fee

2. Pay applicable fee to 2. Accept payment Php100.00 10 minutes Cashier I / II

Cashier's Office and issue Official Cashier's Office, Basement, Medical
Receipt (O.R.) Arts Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
3. Submit O.R to PSMD 3. Receive O.R and
prepare Certificate None 10 minutes Administrative Assistant III

3.1 Sign the None 5 minutes Chief Administrative Officer

Certificate

3.2 Issue the None 5 minutes Administrative Assistant III

Certificate
Property and Supply Management
Division, Basement, Medical Arts
Building

Total None 50 minutes

End of Transaction
Supplier's Registry Certificate

Optional for those Prospective Bidders who will buy the Philippine Bidding Documents.
Office/Division: Procurement Division (BAC Office)

Classification: Complex

Type of Transaction Government to Business

Who may avail: Prospective Bidder

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Certified True Copy of Registration Certificate Securities and Exchange Commission
Department of Trade and Industry (for sole proprietorship)
Cooperative Development Authority (for cooperatives)
2. Certified True Copy of Mayor's Permit City or Municipal (where the principal place of business is located)
3. Certified True Copy of Tax Clearance Bureau of Internal Revenue
(Finally Reviewed and Approved by BIR)
4. Duly Notarized Statement of ongoing Government Company's Head Office
and Private Contracts including contracts awarded
but not yet started, if any, whether similar or not
similar in nature and complexity to the contract to be
bid
5. Duly Notarized Statement of the Bidder's Single Company's Head Office
Largest Completed Contract (SLCC) must be similar
to the contract to be bid, except under conditions
provided for in Sections 23.4.1.3 and 23.4.2.4 of the
IRR within the relevant period as provided in the
Bidding Documents in the case of goods
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
6. Certified True Copy of the prospective bidder's Company's Head Office
Audited Financial Statements, showing, among
others, the prospective bidder's total and current
assets and liabilities, stamped “received” by the BIR
or its duly accredited and authorized institutions, for
the preceding calendar year which should not be
earlier than two(2) years from the date of bid
submission
7. Original Copy of the prospective bidder's Company's Head Office and/or
computation of Net Financial Contracting Capacity Universal or Commercial Bank (for LC)
(NFCC). However, in the case of procurement of
Goods, a bidder may submit a committed Line of
Credit (LC) from a Universal or Commercial bank, in
lieu if its NFCC computation.
8. Certificate of Philgeps Registration (Platinum Philippine Government Electronic Procurement System (PhilGEPS)
Membership)
9. Valid Joint Venture Agreement (JVA) , in case the Company's Head Office (if with JVA) or
joint venture is already in existence. In the absence Potential Joint Venture Partners ( in the absence of JVA)
of a JVA,duly notarized statements from all the
potential joint venture partners should be included in
the bid, stating that they will enter into and abide by
the provisions of the JVA in the event that the bid is
successful. Failure to enter into a joint venture in the
event of a contract award shall be ground for the
forfeiture of the bid security. Each partner of joint
venture shall submit the legal eligibility documents.
The submission of technical and financial eligibility
documents by any of the joint venture partners
constitutes compliance.
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
1. Get the order of payment 1. Issue Order of None 2 minutes BAC Secretariat
for the Certificate of Simplified
Payment for CSSR
Supplier's Registry (CSSR) and Philippine Basement, Medical Arts Bldg.
from BAC Secretariat Bidding Documents
(PBD)
2. Pay the applicable fees at 2. Accept the CCSR Fee – 30 minutes Cashier I / II
the Cashier's Office. payment based on PHP1,500.00
the Issued Order of PBD Fees – Cashier's Office, Basement, Medical
Payment see Standard Arts Building
Rates
3. Present the original Official 3. Accept the None 4 minutes BAC Secretariat
Receipt (OR) and submit the photocopy of the
photocopy to BAC Secretariat OR presented
3.1. Advise the
prospective bidder BAC Office, Basement, Medical Arts
of the schedule of Building
the Pre-Bid
Conference where
the deadline of
submission of the
requirements for
CSSR will be
announced
4. Attend the Scheduled Pre- 4. Conduct Pre-Bid None 30 minutes BAC Chairman
Bid Conference at Cafe 1475 Conference
(MAB Basement) 4.1 Announce the
deadline of the 2 minutes BAC Office, Basement, Medical Arts
submission of the Building
requirement for the
application of
CSSR
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
5. Return to BAC Office for the 5. Receive the None 5 minutes BAC Secretariat
submission of the required required
documents for the Issuance of documents BAC Office, Basement, Medical Arts
CSSR 5.1 Advise the Building
prospective bidder None
to wait for the call
from BAC
Secretariat for the
issuance of CSSR
(if compliant)
5.2. Review the None BAC –Technical Working Group
documents 3 days
submitted (Note: BAC Office, Basement, Medical Arts
The prospective Building
bidder will be
notified if the
documents
submitted are
incomplete and will
be given a deadline
for compliance)
5.3A For Compliant
Bidder: None BAC Secretariat
Prepare CSSR for 1 day
and have it signed BAC Office, Basement, Medical Arts
by the BAC- Building
Chairman
5.3B For Non- None
Compliant Bidder
notify the non-
compliant bidder
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON
PAID TIME RESPONSIBLE
6. Return to BAC Office for the 6. Issue the CSSR None 3 minutes BAC Secretariat
Issuance of CSSR BAC Office, Basement, Medical Arts
Building
None 4 days, 1 hour
Total
and 16 minutes
End of Transaction
Standard Rates

The cost of bidding documents shall correspond to the ABC range as indicated in the table below. This shall be the maximum
amount of fee that procuring entities can set for the acquisition of bidding documents.

Approved Budget for the Contract Maximum Cost of Bidding Documents (in Philippine Peso)

500,000 and below 500.00

More than 500,000 up to 1 Million 1,000.00

More than 1 Million up to 5 Million 5,000.00

More than 5 Million up to 10 Million 10,000.00

More than 10 Million up to 50 Million 25,000.00

More than 50 Million up to 500 Million 50,000.00

More than 500 Million 75,000.00

Per Appendix 8 – Guidelines on the Sale of Bidding Documents per 2016 R-IRR of RA 9184
Telephone Calls
Accepting incoming and outgoing calls is the primary tasks of the General Services Division-Switchboard Section. Incoming
calls includes: Transfer of calls to the desired local number or to the area of concern. Outgoing calls includes: Transfer of
internal calls to an outside number.

Office/Division: GENERAL SERVICES DIVISION

Classification: Simple
Type of Transaction: G2C – Government to Citizen
G2B – Government to Business
G2G – Government to Government
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None Not applicable
FEES TO BE PERSON
CLIENT STEPS AGENCY ACTION PROCESSING TIME
PAID RESPONSIBLE
1. Call the Philippine Heart 1. Receive and attend to none 1 minute Administrative Assistant
Center at telephone number the inquiry of the client. III (Communications
89252401 Equipment Operator III)

Switchboard Office,
Ground floor, MAB
2. Inquire or request for 2. Answer queries/ none 2 minutes Administrative Assistant
connection to a specific local connect the call to the III (Communications
or department. desired local or Equipment Operator III)
department.
Switchboard Office,
Ground floor, MAB

Total none 3 minutes

End of Transaction
 Use of Function Rooms (Outsider)
Utilization of Function Rooms
Office/Division: GENERAL SERVICES DIVISION
Classification: Simple
Type of Transaction: G2C – Government to Citizen
G2G- Government to Government
G2B-Government to Business
Who may avail: All
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Executive Director's approved letter for the Use of Function - Client's Initiative
Room
Function Request Form (3 original copies) - General Services Division, 2nd Floor, MAB
Application for the Use of Function Room (2 original copies) - General Services Division, 2nd Floor, MAB
PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME
RESPONSIBLE
1. Call or Inquire at the 1. Confirm the availability of None 3minutes Administrative
General Services Division function room. Assistant III/
(GSD) to ask for the 1.1 Instruct the client to Administrative
availability of the Function write a letter addressed to Officer I
room. the Executive Director for General Services
(89252401 loc. 3219) the approval for the Use of Division, 2nd Flr.,
General Services Division, function room. MAB
2nd Floor MAB 1.2 Wait for the approval
from the Executive 1 day
Director.
If approve:
1.2 Instruct the client to
proceed to the GSD office
to secure an Application for
the Use of Function Form
and Function Request
Form
2. 2. Proceed to the GSD office 2. Assess the filled out None 30 minutes Administrative
to get and fill out applicable function request form. Officer I and Chief
forms. Administrative
3.
Hospital Support Services
Internal Services
Cafeteria Special Function Request
Hospital Paid Special Functions are service provided by Cafe 1475 to Philippine Heart Center's different divisions, units or sections with
approved request form from the Deputy Executive Director of Hospital Support Services. The request is limited to serving of coffee, tea, juice and
snacks of resource speakers or special guests of the center. All food request outside the allowed list shall be charged to the personal acount of
the requesting person.

Office/Division: Cafe 1475

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: PHC Units
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Personal Paid Function Request Form Cafe 1475 Office
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Secure one (1) copy of 1. Instruct client that request None 5 Minutes Foodservice Supervisor I or
controlled form of Hospital shall be made and submitted to Foodservice Supervisor II
Paid Function Request at the Hospital Support Services
Cafe 1475. three (3) days prior the event.
Cafe 1475 Office
2. Fill out completely all the 2. Guide the client in filling out None 10 Minutes Foodservice Supervisor I or
details of the Hospital Paid the form and instruct them to Foodservice Supervisor II
Function Request form. submit it to the Office of the
Hospital Support Services. Cafe 1475 Office
3. Submit the filled out form 3. Office secretary of the None 10 Minutes Office Secretary and
three (3) days before the Hospital Support Services will Deputy Executive Director
event to the Office of the receive the filled out request
Deputy Executive Director of form and forward it to the Deputy
Hospital Support Services for Executive Director for approval.
approval. Hospital Support Services
Office
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Follow-up the status of their 4. Check the approved request None 10 Minutes Foodservice Supervisor I or
request one (1) day before the from the Hospital Support Foodservice Supervisor II
event at the Cafe 1475 Office. Services. Serve the approved and Food Server
request to the concerned
division,unit or section based on
the details on the form.

Cafe 1475 Office

5. Sign the service slip as 5. File the signed service slips Based on the food 10 Minutes Food Server and Cashier I
acknowledgement of food and charge the total amount of item served
items served food items to the division, unit or
section concerned. Cashier's Area of Cafe
1475
Based on the food 45 Minutes
TOTAL item served

End of Transaction
Car Sticker/Parking
Effective January 1 of every year, all PHC car owners should have an official car sticker, otherwise, no-sticker,no-entry policy is
strictly applied.

Car sticker application is available during the months of November and December of the previous year. Application is on a first
come-first serve basis. Qualified applicants are entitled to one (1) sticker. However, they may request for only two (2) additional car
stickers.

Office/Division: GENERAL SERVICES DIVISION

Classification: Simple
Type of Transaction: G2C-Government to Citizen
Who may avail: PHC employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Car Sticker Application Form -General Services Division

*Car owner is the PHC employee itself -Client Initiative

Photocopy of latest OR (Official Receipt) of the vehicle
applied for and CR (Certificate of Registration)

*PHC Employees name differ from the OR/CR -Client Initiative

Additional requirements is requested such as:

Photocopy of Notarized Deed of Sale and/or Car Assignee

Certificate (company-owned vehicles)

*PHC Employees name differ from OR/CR but the owner is -Client Initiative
their relatives (spouses, parents or siblings)
Notarized Authorization Letter.
 FEES TO BE PERSON
CLIENT STEPS AGENCY ACTION PROCESSING TIME
PAID RESPONSIBLE
1. Proceed to the 1. Instruct the client to None 5 mins. Administrative Assistant
General Services Division fill up the form and General Serivces, 2nd
(GSD) office 2 nd Floor, MAB attached the Floor Medical Arts Bldg
for the copy of the Car Sticker necessary
Application Form requirements.

2. Submit the Filled out Car 2. Forward Car Sticker None 5 mins. Chief Administrative
Sticker Application Form with Application Form to the Officer
the complete requirements. Chief Administrative Officer General Services
for Approval. Division, 2 nd Flr.,
MAB

3. Wait for the announcement 3. If car sticker is available None 1 day

that PHC Car Sticker is for release, Issue an Order
already available for release of payment for PHC Car
Sticker
2.1 Instruct the client to pay
at the cashier and return to
General Services Division
with the copy of the Official
receipt.
4. Get a number and pay the 4. Receive payment and P200.00 1st sticker 10 mins. Cashier on duty
corresponding fee at the issue Official Receipt (OR) P300.00 2nd sticker Cashier's Office,
Cashier's Office. P300.00 3rd sticker Basement, MAB
 FEES TO BE PERSON
CLIENT STEPS AGENCY ACTION PROCESSING TIME
PAID RESPONSIBLE
5. Present Official Receipt at 5. Issue PHC Car Sticker None 10mins. Administrative Assistant
the General Services Division depending on the color General Serivces, 2nd
(GSD) code applied for. Floor Medical Arts Bldg

Blue – Executive Director,

Deputy Executive Directors,
Department Managers (all
services), Division Heads,
all services, Past Director,
Assistan Directors and
Department Managers,
Resident COA Auditor, Past
IERB Chair(s), Senior
consultants, 80 years old
and above (250 stickers)

Yellow - Regular sticker for

vehicles and motorcycles
owned by PHC employees,
Medical Consultants,
Residents/Fellow's and
Tenants staff cars. (850
stickers)

6. Guide the Security sentinel 6. Stick the PHC car sticker None 30 minutes
to the car where it is last on the front wind shield of
parked. Security guards will the vehicle or any other
be the one to stick the visible space in the front
stickers to the front wind portion.
shield.
 FEES TO BE PERSON
CLIENT STEPS AGENCY ACTION PROCESSING TIME
PAID RESPONSIBLE
7. Parking at all designated 7. Monitor that all PHC car None
parking spaces shall be on a stickers are renewed each
FIRST-COME-FIRST- year and is strictly following
SERVED basis. on the rules and guidelines
OVERNIGHT parking is not
allowed.

P200.00 1st sticker 1 day and 1 hour

Total P300.00 2nd sticker
P300.00 3rd sticker

End of Transaction
Certifications for Various Purposes.
Issued for official and personal use of the employees such as Certificate of Employment, Service Record, and Authority to Travel,
GSIS/PhilHealth/Pag-ibig Premiums, Last Salary, On the Job Training, Discount for Dependents. No Pending Case..

Office/Division: Human Resource Management Division

Classification: Simple
Type of Transaction: G2C - Government to Citizen
Who may avail: PHC Employees – Active and Inactive
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request form Human Resource Management Division
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Submit 1. Receive request form Please see 5 minutes HRM Assistant/ Clerk III
accomplished 1.1 Give payment slip. Table of Fees
request form. Human Resource Management Division,
8th flr, MAB
2. Pay applicable 2. Receive payment and issue None 30 minutes Cashier I or Cashier 2
fees to the official receipt (OR)
Cashier’s Office. Cashier’s Office, Basement, MAB
3. Present Official 3. Record Official Receipt Number None 5 minutes
Receipt at the HRMD of the employee. HRM Assistant/HRMO I
counter area
3.1 Prepare Certification 1 day Human Resource Management Division, 8th
flr, MAB
3. Receive certificate 6. Issue the certificate/service None 5 minutes HRM Assistant/ Clerk III
at Releasing record, authority to travel to the
counter area employee. Human Resource Management Division, 8th
flr, MAB
Please see 1 day and 45
Total
table of fees mins
End of Transaction
 PHILIPPINE HEART CENTER
HUMAN RESOURCE MANAGEMENT DIVISION

RATES – AUGUST 1, 2018

VARIOUS CERTIFICATION
1 Service Record
1.1 Presently Employed (personal use: credit card application, etc.) 75.00
1.2 Resigned Employee 150.00
2 Certificate of Employment
2.1 Presently Employed (personal use: credit card application, etc.) 75.00
2.2 Resigned Employee 150.00
3 Certificate of Remittances – Resigned Employee 50.00
4 Certification of Photocopy of Appointment/PDF 50.00

5 Authority to Travel 50.00

6 Certificate of Leave Records

6.1 Presently Employed 125.00
6.2 Resigned Employee 150.00
Disbursement Voucher for Maternity Pay, Special Leave for Women, Honorarium. Salary of Reliever
This benefit/salary/ is prepared for PHC employees and Consultants who goes on maternity leave likewise process the salary of her
reliever and honorarium for the services rendered by the Consultants.

Office/Division: Human Resource Management Division

Classification: Complex
Type of Transaction: G2C Government to Citizen
Who may avail: PHC employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Application Leave Human Resource Management Division
2. Administrative Clearance of Solo/Married HRMD
3. Nursing Services Clearance Form (for Nursing Office of Nursing Services
Employees) HRMD
4. Service Record HRMD
5. Daily Time Record (DTR) Hospital/Place where the employee delivered his/her baby
6. Medical Certificate
7. Contract of Agreement between PHC and Consultant
8. Philgeps
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME

1.Submit approved 1. Receive complete documents None 15 minutes HRMO II, HRM Assistant/
clearance and complete Clerk IV
requirements to the 1.1 Prepare approved Maternity Pay HRMD
HRMD such as None 1 day
Full Pay - two years regular
employee
Pro Rata – more than one year HRM Assistant/Clerk IV
but less than two years None 4 hours HRMD
Half Pay – one year regular or
less
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1.2 Compute for the maternity pay, None 15 minutes HRMO II/HRM Assistant
special benefit and consultants HRMD
honorarium for pre-audit by the
Accounting Division.

1.3 Return to HRMD for preparation None 4 hours Accountant III

of disbursement voucher Accounting Division
.
1.4 Forward to Budget Division for None 4 hours Chief Administrative Officer
approved of Disbursement Voucher Budget Division

1.5 Forward to Accounting Division None

for signature of Disbursement 1 day Chief Accountant
Voucher Accounting Division

1.6 Accounting Division submit to None 4 hours Cash Clerk III

Cashier’s Office for preparation of Cashier’s Office, Basement
Check

1.7 Forward to Office of Hospital None 2 days Deputy Executive Director

Support Services and Executive for
Director for signature of Check Hospital Support Services
Executive Director
2 Receive check 2. Release Check for Maternity None 15 mins Cash Clerk III
for Maternity/Special Pay/Special Benefit for Cashier’s Office
Leave for Women/ Women/Honorarium Basement, MAB
Honorarium
Total None 6 days and 45 mins
End of Transaction
Dispensing of Medicines to PHC Employees

The Dispensing of Medicine to PHC employees is to provide and ensure that patients receive the right drug, right dose, and route at the
right time as prescribed by doctors/linfirmarian.

Office or Division: Pharmacy Annex

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: PHC Employee
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Original Prescription/s from Infirmary clinic Licensed Doctor/Infirmarian
PHC ID PHC employee
FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
PAID TIME RESPONSIBLE
1. Present doctor's prescription and 1. Receive and validates Pharmacist II
None 2 Minutes Pharmacy Division
requirements prescription and requirements.
1.1 Print the Pharmacist II
None 2 Minutes Pharmacy Division
Purchase Order Slip (POS)
1.2 Prepare the medicines per Admin Aide V
None 10 Minutes
POS Pharmacy Division

2. Received prescribed medicines. 2. Dispense of medicines None 2 Minutes

Pharmacist II
Pharmacy Division
TOTAL: None 16 Minutes
End of Transaction
Doctor's Clinic (Application for Clinic Space)
Rental of Doctor's Clinic space.

Office/Division: GENERAL SERVICES DIVISION

Classification: G2C – Government to CItizen
Type of Transaction: Simple
Who may avail: Qualified Doctors
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Letter of Intent Client Initiative
Notarized Contract of Lease – 3 original copies General Services Division
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit a Letter of 1. Receive the Letter of Intent None 1 minute Executive
Intent to the Executive 1.1 Forward the approved letter of Director / Deputy
Director thru the the applicant to facilitate the Executive Director for
Deputy Executive contract. Otherwise, D.O will Medical Services,
Director for Medical inform the applicant on the status nd
2 Flr., Medical Arts
Services. of his/her application for clinic Building
space.
See table of fees 1 day Accounting Staff
1.1 Approved Letter of Intent will Accounting Division,
be forwarded to the Accounting Basement,
Division for computation of rental, Medical Arts Building
recording and accounting
purposes.
None 10 minutes Administrative Assistant III
1.2 Preparation of Contract of General Services Division,
Lease (Prepare 3 sets of Contract 2nd Flr, Medical Arts
of Lease for signature of all the Building
doctors/lessees occupying the
clinic including the applicant /new
tenant
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING PERSON RESPONSIBLE
TIME
2. The applicant 2. The signed contract should be None 1 day Chief Admin. Officer,
together with all the returned back to the General Deputy Exec. Director for
doctors occupying the Services Division for signatures of Hospital Support Services
clinic should sign the the General Services Division and
contract. Chief Admin. Officer, Deputy Accounting
Exec. Director for Hospital Division Chief
Support Services and Accounting Admin. Officer
Division Chief Admin.
Officer 2nd flr, Medical Arts
Building
3. Signed Contract of 3. Receive notarized copy of None 30 minutes Administrative Assistant III
Lease should be Contract of Lease to the GSD for General Services Division,
notarized. record and reference purposes. 2nd flr, Medical Arts
3.1 Distribute the notarized Building
contract of lease 1st copy -new
lessee 2nd copy – Accounting
Division 3rd copy- General
Services Division
Total See table of fees 2 days and 41
minutes
End of Transaction
Dormitory Application- PHC Employee
Utilization of the PHC dormitory.
Office/Division: GENERAL SERVICES DIVISION
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: PHC Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
PHC Dormitory Application Form - 3 copies - General Services Division, 2nd Floor, MAB
PHC Dormitory Contract of Lease - General Services Division, 2nd Floor, MAB
PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
1. Inquire at the General 1. Record the reservation in the none 5 minutes Administrative
Services Division (GSD) office List of Dormitory Reservation Officer I
nd
2 Floor, MAB or call at the logbook General Services
PHC telephone number Division, 2nd Floor,
89252401 local 3219. for the Medical Arts Bldg.
availability of the the dormitory
room or for reservation for
dormitory slot
2. Accomplish PHC Dormitory 2. Approve PHC Dormitory None 5 minutes Administrative
Application Form in triplicate Application Form and Contract Officer I
copy and Contract of Lease of Lease. General Services
2.1 Instruct employee to Division, 2nd Floor,
notarize the Contract of Lease Medical Arts Bldg.
3. Submit Notarized Contract of 3. Endorse one copy each of see 5 minutes Administrative
Lease to GSD the PHC Dormitory Application table of fees Officer I
Form to Accounting Division for General Services
salary deduction of dorm rental. Division, 2nd Floor,
3.1 Retain one copy for record Medical Arts Bldg.
purposes at GSD.
Total see 15 minutes
table of fees
End of Transaction
 GENERAL SERVICES DIVISION

DORMITORY ROOM RATES

Room Type No. of Rooms Room Rate

2-in-1 w/ T & B Nurses' Wing – 6 P 2,400.00 / month
Doctors' Wing – 5
2-in-1 w/o T & B Nurses' Wing – 2 2,100.00 / month
5-in-1 w/ T & B Doctors' Wing – 7 2,100.00 / month
7-in-1 w/ T & B Doctors' Wing – 2 2,100.00 / month
4-in-1 w/o T & B Nurses' Wing – 6 1,800.00 / month
2-in-1 w/o T & B Doctors' Wing – 1 1,500.00 / month
8-in-1 w/o T & B Nurses' Wing – 9 1,500.00 / month
7-in-1 w/o T & B Nurses' Wing – 1 1,500.00 / month
Men's Dormitory 2,400.00 / month
(Regular Beds)
1
Men's Dormitory 120.00 / day
(Transient Beds)
Ladies' Transient Room 120.00 / day
1
(TR 1)
Ladies' Transient Room 120.00 / day
1
(TR 2)
 Dormitory Application-Transient
Utilization of the PHC dormitory.

Office/Division: GENERAL SERVICES DIVISION

Classification: Simple
Type of Transaction: G2C – Government to Citizen, G2G- Government to Government
Who may avail: Doctors, Nurses and Relatives of PHC Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
PHC Dormitory Application Form - 3 copies - General Services Division, 2nd Floor, MAB
PHC Dormitory Contract of Lease - General Services Division, 2nd Floor, MAB
PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
1. Inquire at the General 1. Record the reservation in the none 3 minutes Administrative
Services Division (GSD) office List of Dormitory Reservation Officer I
2nd Floor, MAB or call at the logbook
PHC telephone number General Services
89252401 local 3219. for the Division, 2nd Floor,
availability of the the Medical Arts
dormitory room or for Building
reservation for
dormitory slot
2. Accomplish PHC 2. Approve the None 5 minutes AdminOfficer I and
Dormitory Application Form accomplished forms and Chief
and Order of Payment Form instruct to pay at the Cashier's Admin Officer
in Office. General Services
triplicate copy before Division, 2nd Floor,
payment. Medical Arts
Building
3. Pay applicable fees 3. Receive payment and issue (please see 30 minutes Cashier I
Official Receipt (OR) attached room Cashier's Office,
rates) Basement,
Medical arts
Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING
TIME PERSON
RESPONSIBLE
4. Present OR and Order of 4. Record OR number on the None 2 minutes Administrative
Payment to the GSD Order of Payment. Officer I
4.1Endorse one copy each of
Order of Payment to the General Services
Accounting Division and Division, 2nd Floor,
Dormitory Guard-on-duty. Medical Arts
Retain one copy for record Building
purposes at GSD.
Total (please see 40 minutes
attached room
rates)
End of Transaction
 Function Rooms’ Use (Employees)
Utilization of Function Rooms

Office/Division: GENERAL SERVICES DIVISION

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Function Request Form (3 copies) - General Services Division, 2nd Floor, MAB
PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME
RESPONSIBLE
1. Coordinate with General 1.Confirm the availability of none 3 minutes Administrative
Services Division (GSD) for function room requested Assistant III/
the and issue Function Administrative
availability of Function room Request Form. Officer I
through telephone call at
89252401 loc. 3219 or letter General Services
sent to the Director's office. Division, 2nd Flr.,
MAB
2. Submit the filled-out 2. Approval of Function none 3 minutes Chief Administrative
triplicate copy of the Function Request Officer
Request Form to GSD
2.1 Endorse approved
Function Request form to Administrative
th Housekeeping Section Assistant III/
and Engineering and Administrative
Maintenance Division Officer I

2.2 Notify the client to General Services

proceed to Function Room Division, 2nd Flr.,
MAB
Total none 6 minutes
End of Transaction
Gate Pass for Equipment – PHC Employee
Bringing out of equipment and accessories from PHC premises requires Gate Pass.

Office/Division: Property and Supply Management Division

Classification: Simple

Type of Transaction G2C – Government to Citizen

Who may avail: PHC Employees

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Control Pass Gate Security Posts
Approved Letter of Request for Gate Pass or Routing Concerned Unit of Employee/Director's Office
Slip
List of Equipment Concerned Unit of Employee
PHC Employee's ID Employee
CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
PAID TIME
1. Secure a Control Pass 1. Issue Control None 5 minutes Security Guard on Post
from the guard at Gate of Pass Gate of Entry
entry and/or approved
Letter of Request for Gate 1.1 Approve Letter None 10 minutes Head of Office
Pass or Routing Slip from of Request for Gate Unit of Employee
Employee's Unit for Pass or Routing
personal property. Slip

Secure Director's Office- 1.2 Approve Letter None 10 minutes PHC Executive Director
approved Request for Gate of Request for Gate Director's Office, 2nd Floor, Medical
Pass or Routing Slip for Pass or Routing Arts Building
PHC Property Slip.
 AGENCY ACTION FEES TO BE PROCESSING PERSON RESPONSIBLE
CLIENT STEPS
PAID TIME
2. Submit the Control Pass/ 2. Prepare the Gate None 10 minutes Property Section Staff
approved Request for Gate Pass Property and Supply Management
Pass or Routing Slip and List Division, Basement, Medical Arts
of Equipment to Building

3. Present PHC Employee's ID 3. Sign Gate Pass None 5 minutes Chief Administrative Officer
Property and Supply Management
Division, Basement, Medical Arts
Building

4. Claim Gate Pass 4. Issue Gate Pass None 1 minute Property Section Staff
Property and Supply Management
Division, Basement, Medical Arts
Building
Total 41 minutes

End of Transaction
Job Order Request – Renovation and Construction of Facilities
Provide services for PHC Units in renovation and construction of Facilities.

Office or Division: Engineering and Maintenance Division (EMD)

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: All Philippine Heart Center (PHC) Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Job Order Request Form EMD
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Fill-out manually or online 1. Record at logbook or print None 5 minutes EMD Clerk
Job Order Request Form out JOR for online request at Basement, Medical Arts Bldg.
(JOR) at PHC Intranet PHC Intranet
2. Submit/Send to EMD 2. Receive and classify JOR None 5 minutes EMD Clerk
(Building and Facilities, Basement, Medical Arts Bldg.
Electrical, Mechanical,
Biomedical)

2.1 If materials are available, None 90 days

perform necessary works Contractors

3. Acknowledged completion 3. Upon completion, endorse None 2 minutes EMD Technician

of project to end-user and present Basement, Medical Arts Bldg.
Acknowledgement Report
TOTAL: None 90 days and 12
minutes
End of Transaction
NOTE: Infrastracture projects usually takes time depending on the complexity of the project
Job Order Request – Repair and Maintenance of Equipment and Facilities
Provide services for PHC Units in repair and maintenance of equipment and facilities.

Office or Division: Engineering and Maintenance Division (EMD)

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: All Philippine Heart Center (PHC) Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Job Order Request Form EMD
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Fill-out manually or online 1. Record at logbook or print None 5 minutes EMD Clerk
Job Order Request Form out JOR for online request at
(JOR) at PHC Intranet PHC Intranet
2. Submit/Send to EMD 2. Receive and classify JOR None 5 minutes EMD Clerk
(Building and Facilities,
Electrical, Mechanical,
Biomedical)

2.1 If materials are available, None 20 days EMD Technician

perform necessary works

3. Acknowledged completion 3. Upon completion, endorse None 2 minutes EMD Technician

of project to end-user and present
Acknowledgement Report
TOTAL: None 20 days and 12
minutes
End of Transaction
Learning and Development Program
Any seminar or workshop held within the premises of the institution which aims to contribute to the continuing program for
career and personnel development of employees at all levels, and creates an environment or work climate conducive to the
development of personnel skills, talents, and values for better public service.
Office or Division: Human Resource Management Division
Classification: Highly Technical
Type of Transaction: G2C – Government to Citizen
Who may avail: All Philippine Heart Center Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Human Resource Management Division Information System
Approved by the immediate supervisor and registered in the HRIS
(HRIS)
FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
PAID TIME
1. Log in to Human Resource 1. The Human Resource None 15 Days Human Resource
Information System (HRIS) Management Division Management Officer I
Account and view posted in- (HRMD) will post confirmed HRMD Office, 8th Flr.,
house learning and learning sessions through the MAB
development program or (HRIS)
learning sessions

2. Seek approval from the 2. Prepare Memorandum Order None 2 Days Administrative Assistant III
immediate supervisor. Once for official time to be signed HRMD Office, 8th Flr.,
approved, register to the by the Executive Director MAB
desired in-house learning
session through HRIS
3. Proceed to the in-house 3. Prepare the Attendance None 2 Minutes Administrative Assistant III
learning session in accordance Sheet, Evaluation Forms,
to details posted online (date, check venue, and other
venue, registration time, etc.) materials needed

3.1 Sign on the attendance sheet 3.1 Ensure that the employee will None 2 Minutes Administrative Assistant III
and receive the Learning sign on the attendance sheet HRMD Office, 8th Flr.,
Session Evaluation form and receive the Learning MAB
Session Evaluation form
 FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
PAID TIME
3.2. Sign again on the attendance 3.2. Ensure that the employee will None 2 Minutes Administrative Assistant III
for the afternoon session if sign on the attendance sheet
whole day for afternoon session

3.3. Note all those who didn’t None 2 Minutes Administrative Assistant III
attend the afternoon session HRMD Office, 8th Flr.,
MAB
4. Accomplish Learning Session 4. Collect Learning Session None 10 Minutes Administrative Assistant III
Evaluation Form Evaluation Form HRMD Office, 8th Flr.,
MAB
5. Wait to be evaluated by the 6. Prepare routing slip None 10 Minutes Administrative Assistant III
Supervisor/Division Chief after addressed to concerned
three months division with attached
Training Effectiveness
Evaluation (TEE) Form

5.1 Submit the accomplished TEE 6.1. Receive and check the None 66 Days Administrative Assistant III
Form to HRMD accomplished TEE HRMD Office, 8th Flr.,
MAB
TOTAL None 83 Days, 28
Minutes
End of Transaction
Mutual Benefit Claim
Providing mutual assistance in case of death of an employee or his/her qualified dependent

Office or Division: Human Resource Management Division

Classification: Complex
Type of Transaction: G2C – Government to Citizen
Who may avail: Employees/Employees’ Primary Beneficiary
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Mutual Benefit Claim Form HRMD/Intranet/HRIS
Death Certificate (DC) one (1) photocopy Hospital/Place where the deceased died

FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
1. Submit Mutual Benefit 1. Receive Mutual Benefit Claim None 15 minutes HRMO III
Claim Form and DC form and Death Certificate
photocopy 1.1 Advise employee to HRMD Office, 8th Flr, MAB
Follow up after one
month.
2 Follow up after one month 2 Process the Mutual Benefit None 15 minutes HRMO II
2.2. Deduct f mutual benefit HRM Assistant
from Payroll the amount of HRMD Office, 8th Flr, MAB
Php30/ employee if dependent
expired, and Php50/employee
expired .
Deduction will be done in
succeeding month
 FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
2.3. Prepare Disbursement None 4 hours HRM Assistant
Voucher (DV) and submit Chief Administrative Officer
To Chief Administrative HRMD Office, 8th Flr, MAB
Officer, HRMD for
signature

2.4. Forward to Accounting

Division for review and
signature of DV None 2 days Chief Accountant
Accounting Division
2.5.Accounting to submit to
Cashier’s Office for check Cash Clerk III
preparation. None 4 hours Cashier’s Office
2.6 Forward to office of Hospital Basement, MAB
Support Services & Executive
Director for signature of check None 2 days Deputy of Executive
Director
Executive Director
3. Receive check from 3. Release Check to Employee None 15 minutes Cash Clerk III
Cashier’s Office for mutual or Dependent Cashier’s Office,
benefit Basement, MAB
TOTAL: None 5 days and 30
minutes
End of Transaction
NUTRITION COUNSELING FOR PHC EMPLOYEES
Nutrition Counseling provides individualized nutritional care for encouraging the modification of eating habits and assists in the
prevention or treatment of nutrition-related illnesses.

Office/Division: Nutrition and Dietetics Division

Classification: Simple
Type of Transaction: G2C
Who may avail: PHC Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Doctor's Diet Prescription (1 Original) PHC Infirmary
Latest Blood Chemistry (1 Photocopy) Laboratory Medicine Division
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON
RESPONSIBLE
1. Present Doctor's Diet 1. Receive the required None 5 minutes Registered Nutritionist-
Prescription and latest blood documents. Dietitian
chemistry at the Nutrition 1.1 Check for (9am-6pm Duty)
Clinic, Nutrition and Dietetics completeness.
Division (NDD). 1.2 Give applicable forms Nutrition and Dietetics
and instruct to fill out. Division,
Hospital Building
2.Submit filled out forms to 2 Received filled out None 25 minutes Registered Nutritionist-
Registered Nutritionist- applicable forms. Dietitian
Dietitian, at NDD. 2.1 Screen and assess (9am-6pm Duty)
employee.
2.2 Conduct Nutrition Nutrition and Dietetics
Counseling and give Division
handouts. Hospital Buidling
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON
RESPONSIBLE
3. Receive Diet Instruction None 1 minute Registered Nutritionist-
handouts. Dietitian
(9am-6pm Duty)

Nutrition and Dietetics

Division
Hospital Buidling
Total: None 31 minutes
End of Transaction
Schedule of Nutrition Counseling for Out-Patient
Monday to Friday
10:00am to 4:00pm
Payroll Preparation
Processing of payroll to all employees..(Contract of Service, Contractual, Job Order, Permanent)

Office/Division: Human Resource Management Division

Classification: Highly Technical
Type of Transaction: G2C Government to Citizen
Who may avail: All Active PHC employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Biometrics print-outs Human Resource Management Division (HRMD)
2. Daily Time Record (DTR) HRMD
3. Application for Leave HRMD
4. Copy of (OB) memos HRMD
5. Report of Absences HRMD
6. Promissory Note Deduction Accounting
7. Dormitory Accounting
8. Rental Accounting
9. PHC-EMPC PHC-EMPC
10. DBP Salary Loan Billing Statement Development Bank of the Philippines (DBP)
11. Notice of Deductions Government Service Insurance System (GSIS)
12 .Notice of Longevity Pay HRMD
12. Notice of Step Increment HRMD

CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON RESPONSIBLE

BE PAID TIME
1. Submit all 1.1Update on line DTR –data gathering. None 3 days HRM Assistant/ Clerk III
requirements 1.2 Encode of Official time & business Human Resource Management
1.3 Receive the Confirmed biometrics print- Division
outs/Daily Time Record(DTR) and the
Application for Leave of Absences signed
by the Head of Division.
1.4 Record tardiness/undertime in the
employee’s leave card.
1.5 Forward to the Payroll Section for review
of the report.
CLIENT STEPS AGENCY ACTION FEES TO PROCESSING PERSON RESPONSIBLE
BE PAID TIME
1.6 Tag all employees for inclusion in the
Employment Details.
1.7 Compute and check the leave without pay
based on the employees attendance
1.8 Compute and review the step increment,
longevity pay and adjustments except
those under Contract of Service
1.9 Prepare the Representation and
Transportation Allowance (RATA) of Chief HRMO II, HRM Assistant/Clerk IV
Administrative Officer (SG24) and up to None 5 days Human Resource Management
Executive Director. Division

2. Receive the 2. Inclusion of employees availment of

salary thru approved mutual assistance.
automatic teller 2.1 Prepare Payroll Journal to submit None 1 day Chief Administrative Officer
machine(atm) / To Accounting Human Resource Management
over the counter 2.2 Prepare debit memo Division
DBP 2.3 Prepare Budget Utilization Slip, Prooflist
and Soft copy None 1 day Chief Accountant
2.4 Accounting will prepare Journal Voucher Accounting Division
for Summary and forward to Budget
Division for Budget Utilization
2.5 Upon approval, then back to Accounting for
sign the Journal Voucher None 2 days Deputy Executive Director
2.6 Forward to office of Hospital Support Executive Director
Services and Executive Director for
signature of debit memo
2.7 Accounting Division to forward the debit None 2 days Accountant III
memo at Development Bank of the Accounting Division
Philippines (DBP) for the release of the
salary of the employee.
Total 15 days
End of Transaction
Permission To Work Part Time
A memorandum order issued to employees who wish to engage in other profession or financial endeavour other than their
present government employment
Office or Division: Human Resource Management Division
Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Philippine Heart Center Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Approved Request Letter to work part time To be secured by the requesting employee

Any documents proving existence of part time work To be secured by the requesting employee
FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS
PAID TIME RESPONSIBLE
1. Submit approved letter 1. Receive the approved letter None 2 Minutes Human Resource
from the Director’s Office to of request Management Officer I
Human Resource HRMD Office, 8th flr,
Management Division MAB
(HRMD)
2. Wait for the signed 2. Prepare memorandum order None 15 Minutes Human Resource
memorandum order based on the approved Management Officer I
request letter and forward to
Director’s Office

2.1 Forward signed None 15 Minutes Human Resource

memorandum order to the Management Officer I
requesting employee HRMD Office, 8th flr,
MAB
TOTAL: None 32 minutes
End of Transaction
PERSONNEL RECORDS AUTHENTICATE COPY
Provide authenticate copy of Personnel Records such as Service Record, 201 documents, payslip, BIR 2316, per request of currently
employed and separated employees for various purposes.

Office or Division: HUMAN RESOURCE MANAGEMENT DIVISION

Classification: SIMPLE
Type of Transaction: G2G – Government to Government agency, employee or official
Who may avail: Active & Inactive Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Request form Human Resource Management Division
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit 1 .Receive request form None 1 day HRM Assistant/Clerk
accomplished 1.1 Verify the document IV,HRMO I
request form to the requested if available Counter Area, HRMD
HRMD 1.2 Issue acknowledgement
Receipt if no payment
and give payment slip
2. Pay applicable fees 2. Receive payment and issue See table of fees 30 Minutes Cashier II
to Cashier’s Office – official receipt (OR) Cashier I
Ground floor lobby Cashier’s Office
or basement
3. Present Official 3. Record Official Receipt None 15 Minutes Statistician III
Receipt at the Number of the HRMO II
HRMD counter area employee/authorized HRM Assistant
representative. HRMD
4. Receive at releasing 4. Issue the documents to the None 10 Minutes
counter area employee Statistician III
4.1 by the photocopy/re print HRMO II
the requested document HRMD
4.2 Stamping of “Certified
True Photocopy” & Sign the
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
requested authenticated
documents by the
Statistician III/HRMO II or
any authorized alternate
TOTAL Please see table of 1 day &1 hour
fees
End of Transaction
 PHILIPPINE HEART CENTER
HUMAN RESOURCE MANAGEMENT DIVISION

RATES – AUGUST 1, 2018

1 Service Record
1.1 Presently Employed (personal use: credit card application, etc.) 75.00
1.2 Resigned Employee 150.00

2 Re-printing of Payslip
2.1 Presently Employed 20.00
2.2 Resigned Employee 40.00
3 Written Employment Verification – Resigned Employee 100.00
4 Photocopying of transcript of records, birth certificate 2.00/page
and other personal documents in the 120 file
PROMOTION PROCEDURES
Promotion is the advancement of a career employee from one plantilla position to another with an increase in duties
and responsibilities as authorized by law, and usually accompanied by an increase in salary. Said movement may be
from one department or agency to another or from one organizational unit to another within the same department of
agency.

Office or Division: Human Resource Management Division (HRMD)

Classification: Highly Technical Transaction
Type of Transaction: G2C – Government to Citizen
Who may avail: All currently hired under Permanent position/status with CSC Eligibility
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Application Letter (1 original copy) Concerned Applicant

Personal Data Sheet (1original copy) HRMD; may be downloaded at www.csc.gov.ph

Work Experience Sheet (1 original copy) HRMD

Authenticated PRC License, if the position does not require Professional Regulation Commission – Registration Division
CSC Eligibility (1 original copy, 1 photocopy)

Authenticated Board Rating if the position does not require Professional Regulation Commission – Records Division
CSC Eligibility (1 original copy and 1 photocopy)

Authenticated Civil Service Eligibility, if the position does not Civil Service Commission – Examination Division
require PRC License & Board rating (1 original copy and 1
photocopy)

Latest SPMS – Individual Performance Form (1 photocopy) Concerned Division/Unit

 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Oath of Office (1 original copy) Concerned Division/Unit; HRMD – Recruitment Appointment &
Compensation Section (RACS)

Position Description Form (1 original copy) Concerned Division/Unit; HRMD – RACS

FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
1. Check posting of 1. Publish vacant positions to None 10 days HRM Staff-in-Charge HRMD /
vacancies at www.csc.gov.ph or Recruitment Appointment &
www.csc.gov.ph or www.phc.gov.ph Compensation Section (RACS)
www.phc.gov.ph
HRM Staff-in-Charge HRMD / RACS
1.1 Prepare Notice to possible None 30 minutes
applicants to be promoted
2. Wait for Notice to 2. For PHC Applicant - Send notice None 30 minutes HRM Staff-in-Charge HRMD / RACS
apply to applicant to be promoted

2.1 For Non-PHC For Non-PHC Applicant -

employees – Accept application thru website
send application
letter to Ms.
Jean A. Wong
(Acting Chief,
Human
Resource
Management
Division) located
at 8th floor,
Medical Bldg.,
Philippine Heart
Center, East
Avenue, Quezon
City
 FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
3. Submit application 3. Receive and check for None 15 minutes HRM Staff-in-Charge HRMD / RACS
letter and completeness of application
requirements letter and requirements
HRM Staff-in-Charge HRMD / RACS
3.1 Wait for the 3.1 check if they meet the None 30 minutes
schedule of qualification standards
Government
Employee Exam 3.2 Schedule for Government None 30 minutes HRM Staff-in-Charge HRMD / RACS
and Psychological Employee Exam and
Exam Psychological Exam

3.3 Conduct/Facilitate None 4 hours HRM Staff-in-Charge HRMD / RACS

Government Employee
Examination and
Psychological Examination

3.4 Prepare Comparative None 30 minutes HRM Staff-in-Charge HRMD / RACS

Evaluation of candidate

4. Wait for Notice of 4. Prepare/Issue Notice of None 3 days HRM Staff-in-Charge HRMD / RACS
Deliberation for Deliberation for Promotion by
Promotion by the HRMPSB
Human Resource
Merit Promotion and
Selection Board
 FEES TO PROCESSING
CLIENT STEPS AGENCY ACTIONS PERSON RESPONSIBLE
BE PAID TIME
5. Attend scheduled 5.1Prepare result of deliberation None 45 minutes HRMPSB
deliberation. Office of the Chairperson

HRMPSB
5.2 Sign Summary of None 3 days
Office of the Chairperson
Deliberation

Executive Director
5.2.1 Approve Summary of None 2 days Office of the Executive Director
Deliberation results

5.2.2 Prepare notification of None 10 minutes HRM Staff-in-Charge

results for promotion HRMD / RACS

6. Wait for the Notice 6. For PHC Applicant – notification None 10 minutes HRM Staff-in-Charge HRMD / RACS
of the result of for promotion shall be thru Inter
deliberation Office Memorandum

For Non-PHC Applicants –

notification for promotion shall
be thru email

TOTAL: PHP 0.00 19 days and

20 minutes

End of Transaction
‘Psychological Assessment for Incoming Fellows / Residents
The psychological assessment is conducted to doctors for fellowship / residency training within the institution.
Office or Division: Human Resource Management Division
Classification: Highly Technical
Type of Transaction: G2C – Government to Citizen
Who may avail: All Qualified Doctor Applicants
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Appointment slip Education and Training Department
Official Receipt (OR) Treasury Division
2x2 ID picture (1 piece) To be provided by the applicant doctor
FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS
PAID TIME RESPONSIBLE
1. Submit appointment 1. Check and receive None 5 minutes Human Resource
slip, OR, and 2x2 appointment slip, OR, Management (HRM)
picture and report on and one 2x2 ID picture Assistant
the scheduled exam HRMD
and sign the attendance
sheet at the Human 1.2 Provide attendance None 10 Minutes HRM Assistant
sheet HRMD
Resource Management
Division (HRMD) HRM Assistant
1.3 Brief the test takers None 10 Minutes
HRMD
2. Undergo Psychological 2. Conduct Psychological None 3 hours HRM Assistant
Assessment Assessment HRMD

2.1 Proceed to Education 2.1 Forward Psychological None 7 Days HRM Assistant
and Training Report to Education and HRMD
Department for further Training Department
instructions
7 days, 3
TOTAL hours, 25
minutes
End of Transaction
Public Address
Facilitating of paging requests. Paging Service is necessary to relay messages to all PHC employees, patient and patient's
relatives. Message will be heard thru an overhead paging announcement.

Office/Division: GENERAL SERVICES DIVISION-SWITCHBOARD SECTION

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: PHC Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Paging Request Form - GSD-Switchboard Section, Ground Floor, MAB
2. USB device for overhead recorded voice message – if applicable - Unit Concerned
FEES TO BE PROCESSIN PERSON
CLIENT STEPS AGENCY ACTION
PAID G TIME RESPONSIBLE
1. Proceed to Switchboard 1. Issue a Paging Request Form. none 1 minute Switchboard
Section to get one Paging 1.1 Request the client to fill up the Operator on duty
Request form at the Paging Request form. Switchboard Office,
Switchboard Section. Ground floor, MAB
2. Submit requirements and 2. Receive the Paging Request form none 2 minutes Administrative Officer V
discuss the frequency and 2.1 Coordinate request with the client Switchboard Office,
timing of paging request and approve the request upon Ground floor, MAB
with the Admin. Officer V. completion of requirements.
3. Monitor the paging 3. Announce the message thru the none 1 minute Switchboard
message announced paging phone or play the USB on the Operator on duty
overhead. Switchboard's player (If applicable) Switchboard Office,
Ground floor, MAB
4. If applicable, go back to 4. Return the USB to the client. none 1 minute Switchboard
the Switchboard Section to Operator on duty
get the USB. Switchboard Office,
Ground floor, MAB.
Total none 5 minutes
End of Transaction
Reimbursement Certificate to Employee - Pharmacy
Certification issued to Employee for reimbursement/refund of medicines purchased outside of the hospital pharmacy.

Office or Division: Main Pharmacy

Classification: Simple
Type of Transaction: G2C – Government to Citizen
Who may avail: Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Original Official Receipt (OR) or Sales Invoice Drugstore/Pharmacy
Original prescription Infirmary
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Present and submit 1. Receive and validates the None 2 Minutes Pharmacy staff
doctor's prescription and requirements Pharmacy Division
OR/Invoice 1.2 Record the amount for None 2 Minutes Pharmacist IV
reimbursement in the employee Pharmacy Division
record/ledger
1.3 Prepare the certification for None 5 Minutes Admin Asst II
reimbursement Pharmacy Division
1.4 Affix the respective None 2 days Pharmacy VI
signatures in the certification by Pharmacy Division
the Division Chief and
Department Head. Dept Manager
Ancillary Services
1.5 Call and inform the employee None 2 Minutes Admin Asst II
for pick-up of the certification Pharmacy Division
2. Proceed to releasing 2. Release and issuance of None 1 Minute Pharmacist II
counter certification Pharmacy Division
TOTAL None 2 days and 12 minutes
End of Transaction
Servicing of Facilities Request
Repair and maintenance of Building Facilities, Electrical, Mechanical, Biomedical and Auxiliary

Office or Division: Engineering and Maintenance Division (EMD)

Classification: Simple
Type of Transaction: G2C
Who may avail: All Philippine Heart Center Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Service Request Form EMD
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Contact EMD local 1. Receive call, record at None 5 minutes EMD Clerk/Shifting
4004/4005 Service Request Form. Officer-in-Charge
Classfy type of request and Basement Medical Arts Bldg.
deploy assigned technician.

2. Present to technician 2. Provide appropriate None 3 days EMD Clerk/Shifting

area/equipment the needs services needed and present Technician on Duty
servicing acknowledgement report after Basement Medical Arts Bldg.
completion.

TOTAL: None 3 days and 5 minutes

End of Transaction
Training (Local and Foreign)
Any seminar, workshop, symposium or conference held outside the institution (Local Training) or of the country
(Foreign Training) which aims to contribute to the continuing program for career and personnel development of
employees at all levels, and create an environment or work climate conducive to the development of personnel skills,
talents, and values for better public service
Office or Division: Human Resource Management Division
Classification: Highly Technical
Type of Transaction: G2C – Government to Citizen
Who may avail: Employees with Permanent and Contractual Status of Appointment
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Approved Request Letter To be prepared by the requesting employee
Letter of Invitation with complete details or any communication
To be prepared by the requesting employee
proving the existence of training
Itinerary of travel if request includes transportation allowance, per Human Resource Management Division (Itinerary of Travel
diem, and other incidental expenses Form) and to be filled out by the requesting employee
Signed Training Contract Human Resource Management Division
PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID
TIME RESPONSIBLE
1. Forward the approved 1. Receive and review approved None 10 Minutes Human Resource
letter to Human letter based on existing rules Management Officer I
Resource Management and regulations
Division(HRMD) Human Resource
1.2 Prepare memorandum order None 2 Days Management Officer I
and forward to Director’s Office HRMD Office, 8th flr,
for signature MAB
2. Get the memorandum 2. Photocopy the signed None 15 Minutes Human Resource
order with attachments memorandum order with the Management Officer I
at HRMD following attachments and HRMD Office, 8th flr,
inform employee: MAB
• Routing Slip
• Training Contract
 PROCESSING PERSON
CLIENT STEPS AGENCY ACTIONS FEES TO BE PAID
TIME RESPONSIBLE
2.1 Give voucher to • Voucher and Budget None 5 Minutes Division Chief/
Division Utilization Slip (BUS) if with Department Manager
Chief/Department transportation allowance, Requesting Division
Manager for per diem, and other
signature if with incidental expenses
registration fee, per
diem, and incidental
expenses
3. Forward signed Voucher 3. Receive signed voucher and None 7 days Accountant III
and BUS to Accounting BUS for audit then forward to Accounting Division,
Division Budget Division and Cashier’s Basement, MAB
Office for check preparation
Chief Administrative
Officer
Budget Division,
Basement, MAB

Credit Officer I
Cashier’s Office,
Basement, MAB
4. Claim check at Cashier’s 4. Cashier’s Office will release None 10 Minutes Credit Officer I
Office check Cashier’s Office,
Basement, MAB
5. Submit signed Training 4. Receive Training Contract, None 15 Days after Human Resource
Contract, Certificate of Certificate of Attendance and attendance to Management Officer I
Attendance and Post Post Travel Report training HRMD Office, 8th flr,
Travel Report to HRMD MAB
TOTAL: None 24 Days and 40
Minutes
End of Transaction
Vehicle Request
Servicing of Official Trip of PHC Employees

Office or Division: Engineering and Maintenance Division (EMD)

Classification: Simple
Type of Transaction: G2C
Who may avail: All Philippine Heart Center Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Vehicle Request Form EMD
Trip Ticket EMD
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Fill-out and submit vehicle 1. Verify & arrange schedule None 4 minutes EMD Clerk/Dispatcher
request form at least 2-days of trip
prior to scheduled trip

1.1 Schedule trip and None 2 days EMD Dispatcher

assigned driver

2. Notify/confirm any 3. Prepare Trip Ticket None 1 minute EMD Dispatcher

changes

3. Report to Dispatcher’s 4. Transport passenger to and None Depends on distance EMD Driver
Office on scheduled time of from destination and duration of
departure activity of the
passenger
TOTAL: None 2 days and 5 minutes
End of Transaction
Education, Training and Research Services
External Services
Affiliate Training Program
This is a program for Residents and Fellows from other institutions/hospitals who wish to rotate at Philippine Heart Center.

Office/Division: Medical Training Division

Classification: Complex
Type of Transaction: G2B: Government to Business, G2G: Government to Government
Who may avail: Affiliate Fellows and Residents from other Institutions/Hospitals.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Memorandum of Agreement (3 Copies, original) Referring institution and PHC

2. Endorsement Letter Referring institution

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit 3 copies of 1. Accept 3 copies of MOA None 5 days Medical Training Staff
Memorandum of and endorsement letter
Agreement Legal Office staff
at Medical Training 1.1 Forward to Legal
Division Office, 2nd Office for validation
Floor, M.A.B
(Instruct to comeback
once request is approved)
2. Once request is 2. Give information sheet None 10 minutes Medical Training Staff
approved, comeback to and payment slip
fill up information sheet
at Medical Training
Division Office, 2nd
Floor, M.A.B
3. Pay affiliation fee. Make 3. Receive payment and Affiliation Fee: 10 minutes Cashier
sure to get official issue official receipt P1,200.00
receipt
at Cashier, Basement,
M.A.B
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Present official receipt 4. Issue identification card None 5 minutes Medical Training Staff
to Medical Training and endorse to concerned
Division Department/Division
at Medical Training
Division Office, 2nd
Floor, M.A.B
5. Proceed to concerned 5. Orient affliate and start None None Concerned Department/
Department/Division of training Division
Total P1,200.00 5 days and 25 minutes
Application for Continuing Education Programs (Seminars/Updates)
The process of applying for Seminars/Updates

Office/Division: Nursing Education and Training Division (NETD)

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Non-Philippine Heart Center nurses / nursing students
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
None
PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
1. Pre-register on-line at 1. Maintain an updated None
https://www.phc.gov.ph/training/nursing- website for IV Therapy
education/nureduc/index.php?prog_uid=4 Updates and Nursing
for IV Therapy Updates or Updates/Seminars
https://www.phc.gov.ph/training/nursing-
education/nureduc/index.php?prog_uid=9
for Nursing Updates/Seminars

*Print Notice of Payment if on-line

registration is successful
2. Present Notice of Payment to pay 2. Process the payment P 500.00 30 minutes Cashier’s Office
the prescribed registration fee at the 2.1. Receive payment (Registration Fee Basement, MAB
Cashier’s Office, Basement, MAB 2.2. Issue Official Receipt inclusive of hand-
(O.R.) outs, snacks and
*Secure Official Receipt (O.R.) from certificate of
Cashier’s Office after payment attendance)
3. Present Official Receipt to NETD 3. Receive official receipt None 5 minutes Secretary-on-duty
Office, 2nd floor Medical Arts Building 3.1. Check O.R. NETD Reception Area
(MAB) 3.2. Ask registrant to
write name in
 PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
4 working days prior to the Confirmation Sheet None
scheduled seminar/update 3.3. Copy O.R. number
in Confirmation
∗ *Confirmation of pre- Sheet
registration 4 working days 3.4. Return O.R. to
prior to the scheduled registrant
seminar/update entitles the 3.5. Give instructions on
applicant to hand-outs and details of the
snacks seminar/update
∗ *Non-confirmation of pre- (venue, date and
registration 4 working days time)
prior to the seminar/update
shall be considered on-site
registrants
ON-SITE / WALK-IN ATTENDEES: Process the payment None 30 minutes Cashier’s Office
Pay the prescribed Practicum fee at • Issue Notice of Basement, MAB
the Cashier’s Office, Basement, MAB Payment
• Provide instructions
∗ Secure Notice of Payment from where to pay
NETD prior to payment • Receive payment
∗ Secure Official Receipt (O.R.) • Issue Official Receipt
from Cashier’s Office after (O.R.)
payment
∗ Present O.R. to Program
Coordinator at the
seminar/update venue
 PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
4. Sign PRC Attendance Sheet and 4. Give instructions on the None 4 hours Program Coordinator
attend the seminar/update at the Program Proper: (Half-day) Seminar/Update Venue
designated venue 4.1. Attendees shall
sign in List of
Approved On-line
Registrants Form
4.2. Copy O.R. number
of on-site
registrants to List of
Approved On-line
Registrants Form
4.3. Pre-registrants
shall claim hand-
outs and snacks
4.4. Certificates shall be
provided after the
program
4.5. Program
coordinator shall
issue Certificates of
Attendance after
the program
4 hours and 35
Total P 500.00
minutes
End of Transaction
Application for Learning Development Intervention (LDI) Courses for the Department of Health Nurse
Certification Program (DOH NCP)
The process of applying for Learning Development Intervention (LDI) Course under the Department of Health (DOH) Nurse Certification
Program (NCP) Fund Sponsorship.

Office/Division: Nursing Education and Training Division (NETD)

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Non-Philippine Heart Center nurses
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
If applicant has complied with all the requirements for the Hospital/agency where applicant is employed
particular training course applied for (Critical Care Course
and Peri-Operative Nursing Skills Development Program
Level 2), and the hospital has met the criteria for DOH NCP
fund sponsorship, the following requirements shall be
submitted:

∗ Endorsement Letter/certification indicating the plantilla

position of the applicant who is a permanent staff nurse
of the sending hospital (1 original copy)

∗ Certification indicating that the applicant is not a

recipient of another DOH NCP Learning Development
Intervention from another specialty provider

∗ Memorandum of Agreement (MOA) (3 original copies; Nursing Education and Training Division (NETD) Office
duly accomplished and notarized)

(If within Metro Manila, applicant or hospital

representative shall pick up signed copy of MOA prior to
notarization.)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit additional 1. Receive additional None 10 minutes Secretary-on-duty
requirements for DOH requirements for DOH NCP NETD Reception Area
NCP fund sponsorship at fund sponsorship
NETD Office at 2nd floor of 1.1. Check for completeness
the Medical Arts Building 1.2. Ask registrant to write
(MAB) name in Confirmation
Sheet
1.3. Give information on
details of the training
program (venue, date
and time, attire, options
for accommodation,
etc.)
Total None 10 minutes

End of Transaction
Application for Students’ Hospital Affiliation (Graduate Level)
This is the process of providing Graduate Nursing students from selected Colleges/Universities of Nursing with Practicum Experience in a
Cardiovascular setting.

Office/Division: Nursing Education and Training Division (NETD)

Classification: Simple
Type of Transaction: G2B Government to Business
Who may avail: Nursing School
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request letter for Graduate Students’ Practicum Exposure College / University of Nursing
addressed to Deputy Executive Director (DED) for Education,
Training and Research Services (ETRS) thru NETD Chief and
Training and Education Department Manager (1 original copy)
If request is approved: Nursing Education and Training Division (NETD) Office
Memorandum of Agreement (MOA) (1 original copy) (Client shall pick up signed copy of MOA)

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit request for 1. Receive the request letter None 2 days Secretary-on-duty
Practicum at ETRS 1.1. Check for completeness of
Office, 2nd floor Medical content. ETRS Reception Area
Arts Building (MAB) 1.2. Inform school
representative on the
decision (approval or
disapproval) of the request
1.3. If approved, email copy of
MOA template approved by
PHC Corporate Secretary
for signing by school
authorities.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Submit copy of signed 2. Receive copy of MOA None 30 minutes Secretary-on-duty
MOA to NETD Office at 2.1. Check for completeness
2nd floor MAB (duly accomplished and NETD Reception Area
signed by College /
University of Nursing
authorities)
2.2. Corporate Secretary
recommends approval and
signing of MOA by the
following:
- Deputy Executive Director
(Nursing)
- Deputy Executive Director
(ETRS)
- PHC Executive Director
2.3. Inform the School
representative that MOA
has been approved and
ready for notarization
3. Claim copy of MOA 3. Give copy of signed MOA for None 2 minutes Secretary-on-duty
from NETD Office at 2nd notarization NETD Reception Area
floor MAB 3.1. Ask school representative to
sign file copy
4. Submit notarized copy 4. Receive copy of notarized None 10 minutes Secretary-on-duty
of MOA to NETD Office at MOA NETD Reception Area
2nd floor MAB 4.1. Check for completeness of
MOA
5. Submit request for 5. Receive copy of request for None 1 hour Secretary-on-duty
schedule of Practicum to Practicum schedule NETD Reception Area
NETD Office at 2nd floor 5.1. Check proposed schedule
MAB for Practicum
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
5.2. Recommend approval of Student Affiliation
Practicum schedule Program Coordinator
NETD Office
5.3. NETD Division Chief NETD Division Chief
approves Practicum NETD Office
schedule
5.4. Provide instructions to the Secretary-on-duty
College/University NETD Reception Area
representative on
mechanics of Practicum
(schedule, clinical rotation
guidelines, faculty)
5.5. Issue Notice of Payment
based on number of
students and type of
Practicum, if all
requirements were
submitted
5.6. Provide instructions where
to pay
6. Pay the prescribed 6. Process the payment Practicum fee: 30 minutes Cashier’s Office
Practicum fee at the 6.1. Receive payment Basement, MAB
Cashier’s Office, 6.2. Issue Official Receipt Clinical :
Basement, MAB (O.R.) P5,000.00 per
*Secure Notice of student X 5 days
Payment from NETD
prior to payment Administrative:
*Secure Official P6,000.00 per
Receipt (O.R.) from student X 5 days
Cashier’s Office after
payment
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
7. Present Official Receipt 7. Receive official receipt None 2 minutes Secretary-on-duty
to NETD Office at 2nd floor 7.1. Check O.R.
MAB 7.2. Copy O.R. number in NETD Reception Area
logbook
Students shall report for 7.3. Return O.R. to school
Practicum rotation as representative.
scheduled at NETD, 2nd
floor MAB and Nursing
Clinical Areas
Practicum fee: 2 days, 2 hours & 14
minutes
Clinical:
P5,000.00 per
Total student X 5 days

Administrative:
P6,000.00 per
student X 5 days
End of Transaction
Application for Students’ Hospital Affiliation (Undergraduate Level)
This is the process of providing Level 3 or 4 undergraduate Nursing students from selected Colleges/Universities of Nursing with Related
Learning Experience in a Cardiovascular setting.

Office/Division: Nursing Education and Training Division (NETD)

Classification: Simple
Type of Transaction: G2B Government to Business
Who may avail: Nursing School
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request letter for Related Learning Experience (RLE) College / University of Nursing
addressed to Deputy Executive Director (DED) for
Education, Training and Research Services (ETRS) thru
NETD Chief and Training and Education Department
Manager (1 original copy)
If request is approved: Nursing Education and Training Division (NETD) Office
Memorandum of Agreement (MOA) (1 original copy) (Client shall pick up signed copy of MOA)

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit request for 1. Receive the request letter None 2 days Secretary-on-duty
RLE at ETRS Office, 1.1. Check for completeness ETRS Reception Area
2nd floor Medical Arts of content.
Building (MAB) 1.2. Inform school
representative on the
approval or disapproval
of the request
1.3. If approved, email copy Secretary-on-duty
of MOA template NETD Reception Area
approved by PHC
Corporate Secretary for
signing by school
authorities
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Submit copy of signed 2. Receive copy of MOA None 30 minutes Secretary-on-duty
MOA to NETD Office 2.1. Check for completeness NETD Reception Area
at 2nd floor MAB (duly accomplished and
signed by College /
University of Nursing
authorities)
2.2. Corporate Secretary
recommends approval
and signing of MOA by
the following:
- Deputy Executive
Director (Nursing)
- Deputy Executive
Director (ETRS)
- PHC Executive Director
2.3. Inform the School
representative that MOA
has been approved and
ready for notarization

3. Pick-up copy of MOA 3. Give copy of signed MOA None 2 minutes Secretary-on-duty
from NETD Office at for notarization NETD Reception Area
2nd floor MAB 3.1. Ask school
representative to sign
file copy

4. Submit notarized copy 4. Receive copy of notarized None 10 minutes Secretary-on-duty

of MOA to NETD MOA NETD Reception Area
nd
Office at 2 floor MAB 4.1. Check for completeness
of MOA
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
5. Submit request for 5. Receive copy of request for None 1 hour Secretary-on-duty
scheduling of RLE RLE schedule NETD Reception Area
exposure to NETD 5.1. Check request of
Office at 2nd floor MAB proposed schedule for
RLE
5.2. Recommend approval of Student Affiliation
RLE schedule Program Coordinator
NETD Office
5.3. NETD Division Chief
approves RLE schedule
5.4. Provide instructions to
the College/University
representative on
mechanics of RLE
(schedule, clinical
rotation guidelines,
faculty)
5.5. Issue Notice of Payment Secretary-on-duty
based on number of NETD Reception Area
students and duration of
RLE, if all requirements
were submitted
5.6. Provide instructions
where to pay
6. Pay the prescribed 6. Process the payment Affiliation fee = P 30 minutes Cashier’s Office
affiliation fee at the 6.1. Receive payment 32.00 per student per Basement, MAB
Cashier’s Office, 6.2. Issue Official Receipt day
Basement, MAB (O.R.) (P 160.00 per student
∗ Secure Notice of for 5 days)
Payment from
NETD prior to
payment
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
∗ Secure Official
Receipt (O.R.) from
Cashier’s Office
after payment
7. Present Official 7. Receive official receipt None 2 minutes Secretary-on-duty
Receipt to NETD 7.1. Check O.R. NETD Reception Area
Office at 2nd floor 7.2. Copy O.R. number in
MAB. Students shall RLE Affiliation logbook
report for RLE rotation 7.3. Return O.R. to school
as scheduled at representative.
NETD, 2nd floor MAB
and Nursing Clinical
Areas
P160.00/student for 5 2 days, 2 hours & 14
Total
days minutes
End of Transaction
Basic Life Support, Advanced Cardiac Life Support and Pediatric Advanced Life Support Training Courses
Process for private and government clients for registering, attending training, and for receiving a certificate in Basic Life Support (BLS),
Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Cardiac Life Support (PALS) training courses.

Office/Division: Medical Education Division

Classification: Simple
Type of Transaction: G2G, G2C
Who may avail: Physicians, Nurses, and other Healthcare Providers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. 1 copy of 2x2 ID picture 1. Client

2. Photocopy of company ID 2. Client
3. Appropriate Basic Life Support Certificate/ID (For ACLS and 3. Client
PALS training applications) 4. Employer
4. Certificate of Employment (If government employee wishing 5. Employer
to avail of the government discounted rates).
5. Hospital Order (If government employee wishing to avail of
the government discounted rates).

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Proceed to Medical 1. Have a schedule of BLS, None 10 minutes Training Specialist II

Education Division. ACLS, and PALS trainings. Audio Visual Tech II
1.1. Ask for an available 1.1. Check the schedule for Training Specialist III
slot for the following availability of training/s Medical Education
training/s: and training slot. Division Office
th
− BLS, 1.2. Inform the client if a 5 Floor Medical Arts
− ACLS, and/or schedule and/or slot is Building
− PALS. available. Provide
alternative schedule/s, if
otherwise.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.2. Get confirmation on the 1.3. Check requirements for
availability of desired adequacy and advise if
schedule of training. otherwise. If
Consider alternative/s requirements are
presented, if otherwise. adequate, give the
1.3. If agreeable with the client registration forms.
available training
schedule/s offered,
inform the receptionist
and present
requirements.

2. Fill-out and sign the following 2. Assist client in filling out the None 30 minutes Training Specialist II
forms: forms. Check for Audio Visual Tech II
2.1. Registration form; completeness and Training Specialist III
2.2. Training Terms and correctness in filling out the Medical Education
Conditions; forms. Make sure that Division Office
2.3. Pre-course Letter (BLS/ signatures are affixed where 5th Floor Medical Arts
ACLS /PALS); and needed. Building
2.4. Access form/s for
appropriate e-book/s, if
taking an American
Heart Association
(AHA) training course.

3. Receive Order of Payment 3. Issue an Order of Payment None 2 minutes Training Specialist II
for the fees to be paid. slip. Audio Visual Tech II
3.1. Give instructions on 2 minutes Training Specialist III
payment procedure. Medical Education Office
3.2. Advise client to proceed 1 minute 5th Floor Medical Arts
to the cashier’s office Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
located at the basement
or 4th floor of the
Medical Arts Building
(MAB).

4. Proceed and pay applicable 4. Receive payment and issue Course fees: 30 minutes Cashier I
fees at the Cashier’s Office an official receipt (OR) − BLS: P2,000.00 Cashier II
either at the 4th floor or the − ACLS: P4,000.00 Cashier III
Basement of the MAB. − PALS: P4,000.00 Cashier’s Office
4th Floor or Basement,
Course fees for Medical Arts Building
government
employees:
− BLS: P950.00
− ACLS: P1,250.00
− PALS: P1,250.00

E-book fees:
− BLS: P770.00
− ACLS: P2,070.00
− PALS: P2,440.00

5. Proceed back to Medical 5. Enter the client’s name and None 20 minutes Training Specialist II
Education Division, present OR number on the Audio Visual Tech II
the official receipt, and registration list. Training Specialist III
receive instructions. 5.1. Give instructions on Medical Education Office
how to get the e-book. 5th Floor Medical Arts
5.2. Instruct the client where Building
to proceed on training
day, explain to them the
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
need to come early,
and orient them on the
lock-out policy required
at the start of a video-
based practice-while-
watching type of
training.

6. Attend scheduled training/s. 6. Prepare the training room/s. None Training time: Audio-visual Tech II
6.1. Proceed to the venue 6.1. Provide appropriate − BLS: 4 hours Lead Instructor
before 8:00 in the directional signages to − ACLS: 12 hours (1 Instructors
morning and 1:00 in the the venue. ½ days) Training Room
afternoon to avoid being 6.2. Assist in the registration. − PALS: 16 hours (2 5th Floor Medical Arts
locked out of the 6.3. Conduct training. days) Building
training room. 6.4. Conduct examinations.
6.2. Register your 6.5. Provide remediation
attendance on the when needed.
pad/laptop for the 6.6. Advise clients on what to
electronic data base, do if they still fail after
making sure to correctly appropriate remediations
type your name and have been done.
other information 6.7. Advise clients who have
required. been locked out of the
6.3. Listen and participate in training on their options
the training/s. and what to do.
6.4. Take the written and
practical examination.

7. Wait for certificate/s. 7. Process certificate/s. None 6 hours Audio-visual Tech III
Medical Education Office
5th Floor Medical Arts
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
Building

Course only: - BLS: 11 hours, 35

− BLS: P2,000.00 minutes (1 working
− ACLS: P4,000.00 day, 5 hours, and 35
− PALS: P4,000.00 minutes).

Course and e-book: - ACLS: 19 hours, 35

− BLS: P2,770.00 minutes (2 working
− ACLS: P6,070.00 days, 3 hours, 35
− PALS: P6,440.00 minutes).

Course only for - PALS: 23 hours, 35

government minutes (2 working
Total: days, 7 hours, 35
employees:
− BLS: P950.00 minutes).
− ACLS: P1,250.00
− PALS: P1,250.00

Course and e-book

for government
employees:
− BLS: P1,720.00
− ACLS: P3,320.00
− PALS: P3,690.00

End of Transaction
 PHILIPPINE HEART CENTER
EDUCATION AND TRAINING DEPARTMENT

RATES – AUGUST 1, 2018

NON-PHC PHC GOVERNMENT

COURSES STAFF STAFF EMPLOYEE

BLS 2,000 230 950

ACLS 4,000 270 1,250

PALS 4,000 270 1,250

HEART SAVER/ 1,200 FREE 800

FIRST AID

HEART SAVER 500 FREE 300

Note: Training Materials – an AHA eBook reader can be purchase thru online.

eBooks eBook Price

In Dollars In Peso
BLS 13.25 662.50
ACLS 36.95 1,847.50
PALS 42.50 2,125.00
HEART SAVER/FIRST AID 15.50 775.00
In-Patient Cardiac Rehabilitation Program
Enrolment procedure for the In-patient Cardiac Rehabilitation Program, a supervised exercise program designed for cardiac patients referred for
Cardiac Rehabilitation in the acute care setting.

Office/Division: Cardiac Rehabilitation Section

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Adult Cardiac Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral written in Patients Hospital Chart - Attending Physician
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1 Charge Nurse or Bedside 1. Receive referral None 5 minutes
Nurse of the ward where Clerk IV
patient is admitted will or
relay referral to Cardiac Lab Tech I
Rehabilitation Section
2 Receive Orientation and None
2.1 Orient the patient on the Nurse III
Sign Consent at the
program 15 minutes or
Hospital Room patient is
2.2 Explain the consent form PT I/II/III
admitted
Cashier I
3 Pay Fees 3.1 Charge patient through
*Please see annex or
3.1 patient will be charged Medtrack
for Cashier II
through MedTrack 20 minutes
Price List of Clerk IV
3.2 at the Cashier if credit 3.2 Receive payment and issue
Cardiac Rehab or
suspended Official Receipt (OR)
Lab Tech I
4 Inform Cardiac
Rehabilitation Clerk that
payment has been made
and give Official Receipt Clerk IV
4 Record patient data and OR
Number for verification (if 5 minutes or
Number None
credit suspended, Lab Tech I
otherwise, patient will be
charged through
MedTrack)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
5 Undergo Initial Physical 5.1 Review Records and Medical Officer IV
Exam at the Hospital pertinent results None 15 minutes or
Room patient is admitted 5.2 Conduct Physical Evaluation Medical Officer II

Patient attend and complete the Cardiac Rehabilitation Program done bedside or at the gym

6 Receive discharge
instructions at the
Hospital Room 6 Provide
patient is admitted discharge None 15 minutes PT I/II/III
OR Cardiac instructions
Rehabilitation Gym
(if applicable)
*Please
see annex
for 1 hour 40
Total
Price List minutes
of Cardiac
Rehab
Out-Patient Cardiac Rehabilitation Program
Enrolment procedure for the Out-patient Cardiac Rehabilitation Program—a supervised exercise and health education program designed for
cardiac patients in an out-patient setting.

Office/Division: Cardiac Rehabilitation Section

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Adult Cardiac Patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Referral Letter—1 original copy - Attending Physician
2. Results of ancillary procedures (if not done in Philippine Heart - Medical Records of Hospital of Origin
Center)—1 photocopy
2.1.1. 2D Echo
2.1.2. Angiogram
2.1.3. Medical Abstract
2.1.4. Lab results
2.1.5. Other pertinent results
If payment is through financial assistance/insurance
1. Guarantee Letter - DOH, PCSO, Senate/Congress/Local Government
2. Health Maintenance Organization (HMO) Letter Of Authorization - HMO Coordinator
(LOA)

PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
1. Present referral and Clerk IV
1 Receive requirements
requirements at the Cardiac 5 minutes or
Instruct patient None
Rehabilitation Office Lab Tech I
2. Fill out Patient Data Sheet at 2. Issue Patient Data Sheet Clerk IV
the Cardiac Rehabilitation 2.1 Assist client in filling out of 5 minutes or
None
Office forms Lab Tech I
3. Receive Orientation and 3. Orient the patient on the Nurse III
Sign Consent at the Cardiac program None 15 minutes or
Rehabilitation Office 3.1 Explain the consent form PT I/II/III
 PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
*Please see annex
Cashier I
for
4. Pay Fees at the Cashier 4 Receive payment and issue 20 minutes or
Price List of
Official Receipt (OR) Cashier II
Cardiac Rehab
5. Present Copy of Official Clerk IV
5 Record patient data and OR
Receipt at the Cardiac 5 minutes or
Number None
Rehabilitation Office Lab Tech I
6. Undergo Initial Physical 6.1 Review Records and pertinent Medical Officer IV
Exam at the Cardiac results None 15 minutes or
Rehabilitation Office 6.2 Conduct Physical Evaluation Medical Officer II

Patient attend and complete the Cardiac Rehabilitation Program

7. Answer Patient 7. Ask patient to

Clerk IV
Satisfaction Survey answer Patient
None 5 minutes or
at the Cardiac Satisfaction
Lab Tech I
Rehabilitation Office Survey
Medical Officer IV
8. Receive graduation
8. Provide or
instructions and kit at
Graduation None 30 minutes Nurse III
the Cardiac
instructions and kit or
Rehabilitation Office
PT III
*Please
see annex
for 1 hour 40
Total
Price List minutes
of Cardiac
Rehab
End of Transaction
Request for Statement of Account for Third-Party Payers
Procedure for requesting Statement of Account for enrolment into Out-patient Cardiac Rehabilitation for patients using HMO’s, or other third party
payers to settle account.

Office/Division: Cardiac Rehabilitation Section

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Adult Cardiac Patients using third party payers
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Referral Letter—original OR photocopy - Attending Physician

PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME
RESPONSIBLE
1.1 Prepare Statement of
Account for Third-Party
1. Present referral and specially Clerk IV
Payers
ask for Statement of Account at 20 minutes or
1.2 Release Statement of None
Cardiac Rehabilitation Office. Lab Tech I
Account for Third-Party
Payers to patient
Total None 20 minutes
End of Transaction
 PHILIPPINE HEART CENTER
CARDIAC REHABILITATION SECTION

RATES – AUGUST 1, 2018

Patients in OPD, Patients in Semi-Private Patients in Private

Emergency Room (ER) Rooms including Rooms including Patients
Service and Pay Wards Semi-Private Rooms in Private Rooms in in
PROCEDURE SICU/MICU/CCU/PICU SICU/MICU/CCU/PICU Suite Rooms
NICU/Isolation Rooms
Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL
CARDIAC REHABILITATION PACKAGES
1 PHASE 1 – IN PATIENT

1.1 For Open Heart Surgery (6 visits) 5,800 5,100 10,900 6,670 5,100 11,770 7,550 5,100 12,650 8,400 5,100 13,500

1.2 For Post M.I./CHF (6 visits) 5,800 3,700 9,500 6,670 3,700 10,370 7,550 3,700 11,250 8,400 3,700 12,100

1.3 For Open Heart SPD Surgery (4 visits) 4,650 2,000 6,650 5,350 2,000 7,350 6,050 2,000 8,050 6,750 2,000 8,750

1.4 For Open Heart Surgery (3 visits) 3,300 2,250 5,550 3,800 2,250 6,050 4,300 2,250 6,550 4,800 2,250 7,050

1.5 For post MI/CHF (3 visits) 3,300 2,250 5,550 3,800 2,250 6,050 4,300 2,250 6,550 4,800 2,250 7,050

1.6 PHILHEALTH Z Benefit (5 visits) 5,400 5,400 5,400 5,400 5,400 5,400 5,400 5,400

2 PHASE II – OUT PATIENT WITH 1 TET 10,400 4,965 15,365

Inclusive of 10 lectures

3 COMBINED PHASES I & II WITH 1 TET 16,200 10,065 26,265

Inclusive of 10 lectures
(For open Heart Surgery)
 PHILIPPINE HEART CENTER
CARDIAC REHABILITATION SECTION

RATES – AUGUST 1, 2018

Patients in OPD, Patients in Semi-Private Patients in Private

Emergency Room (ER) Rooms including Rooms including Patients
Service and Pay Wards Semi-Private Rooms in Private Rooms in in
PROCEDURE SICU/MICU/CCU/PICU SICU/MICU/CCU/PICU Suite Rooms
NICU/Isolation Rooms
Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL Hospital PF TOTAL

4 COMBINED PHASES I & II WITH 1 TET 16,200 10,065 26,265

Inclusive of 10 lectures
(For post MI)
5 PHASE III – MAINTENANCE

5.1 One (1) month – 12 sessions 4,400 2,275 6,675

5.2 Two (2) Months – 24 sessions 7,000 3,310 10,310

5.3 Three (3) Months – 36 sessions 10,550 4,965 15,515

6 PROJECT HOPE
Health Optimization Through Prevention 11,300 5,240 16,540
and Exercise)-CHF
Six (6) Weeks – 16 sessions

7 TREADMILL EXERCISE TEST 1,640 295 1,935 1,885 340 2,225 2,130 385 2,515 2,380 425 2,805

8 ELECTROCARDIOGRAM 460 90 550 530 105 635 600 115 715 665 130 795

9 CCREP Intradialytic Rehab Program* 11,350 5,240 16,590

* Effective July 10, 2019
Clinical Trial (1 or 2 site)
Philippine Heart Center-Institutional Ethics Review Board is level 3 PHREB accredited and FERCAP recognized.
This implies that IERB can review Clinical Trials

Office/Division: Institutional Ethics Review Board

Classification: Highly Technical
Type of Transaction: G2B: Government to Business
Who may avail: Pharmaceutical Companies/Principal Investigator
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
A. Initial Review

1. Protocol package (1 original, 10 - Primary Investigator/Clinical Trial Research Division Staff/Study Coordinator
photocopies)
2. Informed Consent Form (ICF) English
and Filipino Version
3. Letter of request for protocol review
4. Philippine Food Drug Administration
(PFDA) approval
5. Curriculum Vitae and Good Clinical
Practice Certificate of Primary and
Sub-Investigator
5. Certificate of Insurance
6. Filled out Initial application form and
document receipt
7. Letter of intent addressed to Chair and
Clinical Trial Research Division head
8. Official Receipt (O.R.)
B. Resubmission
1. One (1) copy of revised protocol - PI/Study Coordinator
package

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

C. Continuing Review Requirements
1. Filled out Continuing Review Form - PI/Study Coordinator
2. If with changes by the Principal
Investigator
- One (1) copy of revised protocol
and ICF
- Original copy of protocol with
highlights of changes
- Amendment application form
D. Early Study Termination
1. Filled out Study termination form - PI/Study Coordinator
2. Letter requesting to terminate
E. Final Study
1. Filled out final study report form - PI/Study Coordinator
2. One (1) copy of completed paper with
an abstract

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
A. Initial Review
1. Submit 1..Check requirements, None 14 days IERB Staff
requirements stamp "received" and
and receive sign the document
statement of receipt form.
account for 1.1 Provide a copy of
Ethics review document receipt form
fee and to PI/study coordinator.
Institutional
Fee 1.2 Sign CTRD
receiving copy logbook.
(IERB Office
1.3 Record and
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
(8/F MAB) encode protocol and
assign IERB number.
(CTRD office
9/F MAB) 1.4 Prepare receipt and
assessment form of
protocol package and
distribute to
designated members
for review.

1.5 File the original

protocol package.
1.6 Include in the Designated reviewers
agenda of the next
IERB meeting.

1.7 Issue statement of

account.

1.8 Instruct to request

statement of account
to CTRD and wait for
date of presentation.
2. Pay applicable 2. Receive payment P 40,000.00 20 minutes Cashier
fees and issue official P 100,000.00
(Cashier- receipt
Basement,
hospital building
ground floor)

Make sure to get

official receipt
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Present official 3. Photocopy official None 10 minutes IERB Staff
receipt to IERB receipt, stamp received
(8/F MAB) and and file
to CTRD (9/F
MAB) 3.1 Return original copy

3.2 Instruct to wait for

SMS notification of the
date of presentation.

3.3 Instruct to present

the original receipt of
Institutional Fee to
CTRD.
4. Come back to 4. Evaluate the None 1 day Designated Reviewer
IERB office for protocol/documents
presentation of (Scientific and
protocol Informed consent
form) Primary/Designated
Reviewer
4.1 Summarize the
findings Board Secretary

4.2 Record the decision

of IERB and instruct
client to wait for any
modifications
4.3 Prepare decision None 5 days IERB Staff
and send to PI

4.4File the receiving

copy
Total P 140,000.00 20 days
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
B. Resubmission
1. Submit one 1. Receive, check and None 14 days IERB Staff
(1) copy of stamp “RECEIVED”
revised revised protocol
protocol package.
package 1.1 Notify and
distribute
protocol package
to chair and
designated
reviewer.
1.2 Include in the
agenda of the
next meeting
2. Present and review None 1 day Designated reviewer
protocol in an en
banc meeting Board Secretary
2.1 Record decision

3. Prepare decision None 5 days IERB Staff

and send to PI
3.1 File the
receiving copy

Total None 20 days

C. Continuing Review Schedule (2 months before expiration of approval)
1. Wait for notice 1. Check and track the None 1 day IERB Staff
of schedule of dates of approved
continuing protocols
review 1.1 Send reminder
letter to PI with
statement of accounts
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.2 Remind to submit
progress report or final
study report two months
before the due date
2. Submit filled- 2..Check for None 1 hour IERB Staff
out continuing completeness of
review form continuing review
and progress form and progress
report. report.
2.1 Stamp
“RECEIVED”
2.2 Include in the
agenda of the
next meeting
3. Pay applicable 3..Receive payment P 10,000.00 20 minutes Cashier
fees and and issue official
photocopy receipt
official receipt
(Cashier-
Basement
MAB)
4. Present official 4. Check official receipt, None 5 minutes IERB Staff
receipt and receive and file
submit photocopy
photocopy of 4.1 Instruct to wait for 14 days
official receipt schedule of the
(IERB office) next meeting and
result of
deliberation
5. Wait for the 5. Deliberate and arrive None 1 day IERB Board Members
result of the at a decision. Board Secretary
deliberation 5.1 Record the
(PI study site) decision.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
6. Receive 6..Prepare and send None 5 days IERB Staff
decision decision to PI
handed 6.1 File the
personally to receiving copy
PI study site by
IERB staff and
sign receiving
copy.
Total P 10,000.00 20 days
D. Early Study Termination
1. Submit Early 1. Receive and verify None 30 minutes IERB Staff
study study termination form
termination and letter requesting to
form and letter terminate the study
requesting to 1.1 Include in the
terminate the agenda of the next
study meeting, review
(study is and archive. 14 days
terminated
upon receipt
of the letter,
no need to
wait for next
IERB
meeting)

Total None 14 days

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
E. Final Study Report
1. Submit filled 1. Receive and stamp None 30 minutes IERB Staff
out final study filled-out final study
report form report form and copy
and one (1) of completed paper.
copy of 1.1 Include in the
completed agenda of the next
paper meeting.
(make sure to
get
acknowledge
ment receipt.
2. Present, deliberate None 14 days Designated Reviewer
and archive final study IERB Board
report.
Total None 14 days
End of Transaction
Clinical Trials (3 or more sites)
Philippine Heart Center-Institutional Ethics Review Board is level 3 PHREB accredited and FERCAP recognized which implies
that the IERB can review Clinical Trials and send to Single Joint Review Ethics Board (SJREB).

Office/Division: Institutional Ethics Review Board

Classification: Highly Technical
Type of G2B: Government to Business
Transaction:
Who may avail: Pharmaceutical Companies/Principal Investigator
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
A. Initial Review

1. Protocol package (1 original, 4 photocopies) - PI/CTRD staff/Study Coordinator

2. Informed Consent Form (ICF) English and
Filipino version
3. Letter of request for protocol review
4. Philippine Food Drug Administration (PFDA)
approval
5. Curriculum Vitae and Good Clinical Practice
Certificate of Primary and Sub-Investigator
6. Certificate of Insurance
7. Filled out initial application form and document
receipt
8. Letter of intent addressed to Chair and CTRD
head
9. Official Receipt (O.R.) or letter approved to
waive fees
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
B. Resubmission
1. One (1) copy of revised protocol package - PI/Study Coordinator
C. Continuing Review Requirements
1.1 Filled out Continuing Review Form - PI/Study Coordinator
1.2 If with changes by the Principal Investigator
- One (1) copy of revised protocol and ICF
- Original copy of protocol with highlights of
changes
- Amendment application form
D. Early Study Termination
1. Filled out Study termination form - PI/Study Coordinator
2. Letter requesting to terminate
E. Final Study
1. Filled out final study report form - PI/Study Coordinator
2. One (1) copy of completed paper with an
abstract
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
A. Initial Review
1. Submit requirements 1..Check requirements, None 14 days IERB Staff
and receive stamp "received" and
statement of account sign the document
receipt form.
for Ethics review fee
1.1 Provide a copy of
IERB Office (8/F document receipt
form to PI/study
MAB)
coordinator.
1.1 Receive 1.2 Sign CTRD
receiving copy
statement of
logbook.
account for 1.3 Record and encode
Institutional Fee protocol and assign
IERB number.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
(CTRD office 9/F 1.4 Prepare receipt and
MAB) assessment form of
protocol package
1.2 Submit electronic and distribute to Designated Reviewer
copy to Single designated
Joint Ethics members for
review.
Board office
1.5 File the original
(DOH, San protocol package.
Lazaro 1.6 Include in the
Compound agenda of the next
Manila) IERB meeting.
1.7 Issue statement of
account.
1.8 Instruct to request
statement of
account to CTRD.
1.9 Instruct to submit
electronic copy of protocol
package to SJREB and
wait for date of
presentation.
2. Pay applicable fees 2..Receive payment and P 40,000.00 20 minutes Cashier
(Cashier-Basement, issue official receipt P 100,000.00
hospital building
ground floor) make
sure to get official
receipt
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Present official receipt 3..Photocopy official None 10 minutes IERB Staff
to IERB receipt, stamp received
(8/F MAB) and to and file
CTRD (9/F MAB) 3.1 Return original
copy
3.2 Instruct to wait for
SMS notification of
the date of
presentation.
3.3 Instruct to present
the original receipt
of Institutional Fee
to CTRD.
4. Come back to IERB 4. Evaluate the None 1 day Designated Reviewer
office for presentation protocol/documents
of protocol (Scientific and Informed
4.1 Present the consent form)
protocol in SJREB 4.1 Summarize the Primary/Designated
meeting findings Reviewer
4.2 Record the
decision of IERB Board Secretary
and instruct client
to forward the
recommendation to
SJREB and wait for
review meeting to
present the
protocol in SJREB
office.
5..Prepare decision and None 5 days IERB Staff
send to SJREB and file
the assessment form.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

Total P 140,000.00 20 days

B. Resubmission (Site Specific Concern)
1..Submit one (1) copy 1..Receive, check and None 14 days IERB Staff
of approved protocol stamp “RECEIVED”
package by SJREB approved protocol
package.
1.1 Notify and distribute
protocol package to
chair and designated
reviewer.
1.2 Include in the
agenda of the next
meeting
2..Present and check if None 1 day IERB Board Members
compliance with site
specific concern in an
en banc meeting Board Secretary
2.1 Record decision

3. Prepare decision and None 5 days IERB Staff

send to PI
3.1 File the receiving
copy

Total None 20 days

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
C. Continuing Review Schedule (2 months before expiration of approval)
1. Wait for 1. Check and track the dates of None 1 day IERB Staff
notice of approved protocols
schedule of 1.1 Send reminder letter to PI
continuing with statement of accounts
review 1.2 Remind to submit progress
report or final study report
two months before the due
date
2. Submit filled- 2..Check for completeness of None 1 hour IERB Staff
out continuing continuing review form and
review form progress report.
and progress 2.1 Stamp “RECEIVED”
report. 2.2 Include in the agenda of
the next meeting
3. Pay 3..Receive payment and issue P 10,000.00 20 minutes Cashier
applicable official receipt
fees and
photocopy
official receipt
(Cashier-
Basement
MAB)
4. Present 4..Check official receipt, receive None 5 minutes IERB Staff
official receipt and file photocopy
and submit 4.1 Instruct to wait for schedule
photocopy of of the next meeting and 14 days
official receipt result of deliberation
(IERB office)
5. Wait for the 5. Deliberate and arrive at a None 1 day IERB Board Members
result of the decision. Board Secretary
deliberation 5.1 Record the decision.
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
6. Receive 6..Prepare and send decision to None 5 days IERB Staff
decision PI
handed 6.1 File the receiving copy
personally to
PI study site
by IERB staff
and sign
receiving
copy.

Total P 10,000.00 20 days

D. Early Study Termination
1. Submit Early 1..Receive and verify study None 30 minutes IERB Staff
study termination form and letter
termination requesting to terminate the
form and study
letter 1.1 Include in the agenda of the
requesting to next meeting, review and 14 days Designated Reviewer
terminate the archive.
study
(study is
terminated
upon receipt
of the letter,
no need to
wait for next
IERB
meeting)

Total None 14 days

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
E. Final Study Report
1. Submit filled 1..Receive and stamp filled-out None 30 minutes IERB Staff
out final final study report form and copy
study report of completed paper.
form and one 1.1 Include in the agenda of
(1) copy of the next meeting.
completed
paper
(make sure to
get
acknowledge
ment receipt.
2. Present, deliberate and archive None 14 days Designated Reviewer
final study report. IERB Board

None 14 days
Total
Continuing Education Programs
The process of applying for the following Continuing Education Programs: Critical Care Course, Peri-operative Nursing Skills Development
Program Level 2, Continuous Renal Replacement Therapy Training, and Cardiovascular Laboratory Training for Allied Health
Professionals.

Office/Division: Nursing Education and Training Division (NETD)

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Non-Philippine Heart Center nurses
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
For Critical Care Course:
1. Application Form 1. NETD Office, 2nd floor Medical Arts Building (MAB)
2. One (1) passport size picture (1 original copy) to be attached to 2. Applicant
application form. 3. Applicant
3. Photocopy of valid Professional Regulation Commission (PRC) 4. Applicant/PRC
license (1 copy) 5. Hospital/Agency where applicant is employed
4. Valid PRC Card to be presented for verification of photocopy. 6. NETD Office
5. Certificate of clinical nursing experience for at least 6 months (1
original copy)
6. Qualifying examination and interview
For Peri-Operative Nursing Skills Development Program Level 2:
1. Application Form 1. NETD Office
2. One (1) passport size picture (1 original copy) to be attached to 2. Applicant
application form. 3. Applicant
3. Photocopy of valid Professional Regulation Commission (PRC) 4. Applicant/PRC
license (1 copy) 5. Hospital/Agency where applicant is employed
4. Valid PRC Card to be presented for verification of photocopy. 6. Hospital/Agency where applicant is employed
5. Certificate of Operating Room Nursing experience for at least 6 7. Any accredited Intravenous Therapy Training provider
months (1 original copy)
 6. Medical Certificate/Clearance (1 original copy)
7. Intravenous Therapy Competency Certification/Card (1 original
copy for checking and 1 photocopy)

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

For Continuous Renal Replacement Therapy Training:
1. Application Form 1. NETD Office
2. One (1) passport size picture (1 original copy) to be attached to 2. Applicant
application form. 3. Applicant
3. Photocopy of valid Professional Regulation Commission (PRC) 4. Applicant/PRC
license (1 copy) 5. Any accredited Intravenous Therapy Training provider
4. Valid PRC Card to be presented for verification of photocopy.
5. Intravenous Therapy Competency Certification/card (1 original
copy for checking and 1 photocopy).
Cardiovascular Laboratory Training for Allied Health
Professionals:
1. Application Form 1. NETD Office
2. One (1) passport size picture (1 original copy) to be attached to 2. Applicant
application form. 3. Applicant
3. Photocopy of valid Professional Regulation Commission (PRC) 4. Applicant/PRC
license (1 copy) 5. Hospital/Agency where applicant is employed
4. Valid PRC Card to be presented for verification of photocopy. 6. Hospital/Agency where applicant is employed
5. Certificate of ICU experience for at least 6 months (1 original copy) 7. Any accredited BLS/ACLS/PALS provider
6. Medical Certificate/Clearance (1 original copy) 8. Any accredited ECG Training provider
7. BLS and ACLS/PALS certification (1 photocopy)
8. Certificate of ECG Training (1 photocopy)
PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
 1. Submit application form and complete 1. Receive the None 20 minutes Secretary-on-duty
requirements at the NETD Office. application form and NETD Reception Area
(Except for Critical Care Course requirements
applicants, those applying for other 1.1. Check for
Continuing Education Programs with completeness. If
complete requirements shall proceed otherwise,
to Step 6 after Step 1.) advise to
complete
requirements.
PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
1.2. For Critical Care
Course
applicants, issue
Notice of
Payment for
examination fee.
1.3. Provide
instructions
where to pay:

Cashier’s
Office,
Basement, MAB

1.4. Applicant for

Critical Care
Course shall be
scheduled for
qualifying
examination and
interview
2. Applicant for Critical Care Course shall 2. Process the P 100.00 30 minutes Cashier’s Office
 pay the prescribed examination fee at the payment Basement, MAB
Cashier’s Office, Basement, MAB. 2.1. Receive correct
 Secure Notice of Payment from NETD payment
prior to payment 2.2. Issue Official
 Secure Official Receipt (O.R.) from Receipt (O.R.)
Cashier’s Office after payment
3. Applicant for Critical Care Course shall 3. Receive official None 5 minutes Secretary-on-duty
present O.R. at NETD Office, 2nd floor receipt NETD Reception Area
MAB 3.1. Check O.R.
PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
3.2. Ask registrant to
write name in
Confirmation
Sheet
3.3. Copy O.R.
number in
Confirmation
Sheet
3.4. Return O.R. to
registrant
3.5. Give instructions
on details of the
qualifying
examination
(venue, date and
time)
4. Applicant for Critical Care Course shall 4. Screen applicants None 8 hours Program Coordinator
take written examination and attend 4.1. Conduct written NETD Office (or
interview at NETD Office at 2nd floor MAB examination and designated venue)
(or at the designated venue) interview
4.2. Process
 screening
4.3. Forward list of
qualified
applicants to
Management
Information
System Division
for uploading
onto the PHC
website.
PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
5. Applicant for Critical Care Course shall 5. Upload list of None 4 hours Programmer on Duty
view list of qualified applicants online at qualified applicants Management
https://www.phc.gov.ph/training/nursing- online. Information System
education/nureduc/index.php?prog_uid=1 Division

6. Accepted applicants shall pay the 6. Process the Critical Care 30 minutes Cashier’s Office
prescribed registration fee at the payment Course (CCC): Basement, MAB
Cashier’s Office, Basement, MAB 6.1. Receive P10,000.00
 Secure Notice of Payment from NETD payment
prior to payment 6.2. Issue Official Peri-Operative
 Secure Official Receipt (O.R.) from Receipt (O.R.) Nursing Skills
Cashier’s Office after payment Development
Program Level 2
(PNSDPL2):
P40,000.00

Continuous Renal
Replacement
Therapy Training
(CRRT):
 P6,000

Cardiovascular
Laboratory
Training for Allied
Health
Professionals
(CLTAHP):
P30,000.00

PROCESSING PERSON
CLIENT STEPS AGENCY ACTION FEES TO BE PAID
TIME RESPONSIBLE
7. Present O.R. and receive instructions on 7. Receive official None 10 minutes Secretary-on-duty
details of the training program at NETD receipt NETD Reception Area
Office, 2nd floor MAB 7.1. Check O.R.
7.2. Ask registrant to
write name in
Confirmation
Sheet
7.3. Copy O.R.
number in
Confirmation
Sheet
7.4. Return O.R. to
registrant
7.5. Give instructions
on details of the
Training
Program to be
attended (venue,
date and time,
attire, options for
accommodation,
etc.)
Total Registration Fees: Continuing
Education
 CCC: Programs other
P10,000.00 than Critical Care
 PNSDPL2: Course: 1 hour
P40,000.00
 CRRT: Critical Care
P6,000.00 Course: 13 hours
 CLTAHP: and 35 minutes
P30,000.00 (1 working day, 5
hours, and 35
 minutes)

End of Transaction
Availment of Executive Check-up Diagnostic Packages
In-Patient Executive Check-up provides a holistic and patient-friendly service for wellness diagnostics aimed for prevention and early
recognition of diseases.

Office/Division: Preventive Cardiology/ Executive Check-up Office (ECU)

Classification: Simple
Type of Transaction: G2C Government to Citizen
Who may avail: Ages 18 and above with non-communicable disease
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Valid Identification Card (ID) − From the patient
2. Letter of Authorization (LOA) − Company/HMO Coordinator
If payment is through Health Maintenance Organization (HMO) or
sponsored by company.
FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
1. Reserve a slot for 1. Inform/explain to the None 10 minutes
ECU: patient/client the different check-
1.1. During office hours call the up packages. ECU Coordinator/Clerk
Executive Check-up Coordinator at ECU Office, 4th Flr. Petal 4A Hospital
925-2401 local 2474.
Clerk
1.2. Beyond office hours and on
Admitting Section, Ground Flr.
Sat/Sun – call Admitting Section at Hospital
925-2401 local 2103 or 2104.

2. Proceed to Admitting Section on 2. Process admission. None 10 minutes Clerk

the day of admission. 2.1. Transport patient to assigned Admitting Section, Ground Flr.
2.1. Present requirements. room. Hospital
2.2. Fill out and sign applicable
document at Admitting Section.

3. Provide important Medical 3. Obtain medical information. None 30 minutes Nurse/Cardio Fellow on duty
information to Cardio Fellow and 3.1. Give instructions regarding Petal 5A, Hosp. Bldg.
nurse on duty. execution of diagnostic tests.
4. Cooperate with the different 4. Perform requested None 30 mins/test Medtech/Radtech/ Resp.Tech on
Diagnostic units for the performance procedures. duty
of medical procedures. Applicable Diagnostic Units

5. Wait for the billing statement. 5. Coordinate with the Billing None 2 hrs Nurse on duty
Section. Petal 5A
5.1. Provide billing statement. Billing Clerk
5.2. Get the billing statement. Billing Section, Basement
Nursing Aide
Petal 5A
6. Pay applicable fees at the 6. Receive payment and issue See Price List 30 mins Cashier
Cashier’s office. Make sure to get official receipt (OR). CPE, CVCU Cashier’s Office, Basement
official receipt. & ECU

7. Secure and understand 7. Give necessary instructions: None 30 mins

discharge 7.1. Doctors/ Nurses instruct Nurse/Cardio Fellow on duty
instructions. patient’s home medications. Petal 5A, Hosp. Bldg
7.2. DND Staff performs nutrition
Dietitian/Nutritionist
and dietary counselling to patient/
Division of Nutrition and Dietetics
relative.
7.3. Provides patient’s portfolio Coordinator/Clerk
with the available results. ECU Office

8. Present discharge slip approved 8. Accept discharge None 5 mins Guard

by the Cashier’s office to guard at slip. Hospital Lobby
Hospital Lobby.
Please see 24 hrs – CPE
table of fees and CVCU
Total below. 48 hrs – ECU
CPE & CVCU
(optional)
End of Transaction
 PHILLIPPINE HEART CENTER
EXECUTIVE CHECK-UP DIAGNOSTIC PACKAGES
OCTOBER 15, 2018

24 HOURS 48 HOURS
DIAGNOSTIC PACKAGES
MALE FEMALE MALE FEMALE

CARDIO-PULMONARY EXAMINATION (CPE)

Single Occupancy 26,300.00 27,300.00 31,700.00 32,700.00
Double Occupancy 25,300.00 26,300.00 30,700.00 31,700.00

CARDIOVASCULAR CHECK-UP (CVCU)

Single Occupancy 30,500.00 31,500.00 35,900.00 36,900.00
Double Occupancy 29,500.00 30,500.00 34,900.00 35,900.00

EXECUTIVE CHECK-UP (ECU)

Single Occupancy 42,150.00 43,150.00
Double Occupancy 41,150.00 42,150.00
Subspecialty Fellowship, Fellowship and Residency Training
Application to the Training Programs opens three months prior to the start of the program. The Training and Education Department shall
post in the hospital bulletin board the opening of the application period. All applicants shall be screened by the Training and Education
Department in coordination with the specialty Department/Sections. Qualified applicants will be scheduled by the Training and Education
Department for a written examination and interview.

Office/Division: Medical Training Division

Classification: Complex
Type of Transaction: G2C: Government to Citizen
Who may avail: Medical Doctors Applying for Subspecialty Fellowship, Fellowship and Residency Training Program
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Medical Diploma, Transcript of Records and General Medical School

Weighted Average (Certified True Copy)

2. PRC License and Board Rating (Certified True Copy) Profession Regulation Commission

3. Three letters of Recommendation with one letter written Medical School or Officer from previous training programs
by the Training Officer &/or Director of the previous
Training Programs for Fellowship Applicants and the
Dean of school or former medical professors for
Residency Applicants.

4. Five (5) copies of 2'' x 2'' colored picture Applicant

5. Certificate of Residency From the previous institution/training programs

(for Fellowship and Subspecialty Fellowship Applicants –
Certified True Copy)
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
8. Certificate of Fellowship From the previous institution/training programs
(for Subspecialty Fellowship Applicants –Certified True
Copy)

9. Specialty Board Certificate (Certified True Copy) Specialty Board

10. Research Protocol Applicant

(for Subspecialty Fellowship Applicants)

11. Information Sheet Medical Training Office

(available at Medical Training Division)

12. PRC ID (photocopy back to back) Applicant

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Inquire/check the 1. Publication of available
general requirements positions in PHC web Medical Training Staff
None 1 working day
for application at the page and local At PHC official website
PHC website newspapers
2. Validation/Acceptance
2. Submission of Application Fee: P500.00
of completed requirements
completed Medical Training Staff
for application by the 15 minutes
requirements for Psychological Examination
Department and payment
application P400.00
of fees
3. Advice from Training
3. Application to take the and Education Department
psychological testing (TED) on schedule of
None 5 minutes Medical Training Staff
and written entrance written examination and
examination psychological testing
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
Psychological
Human Resource Staff
4. Assist the applicant to Examination:
4. Take the psychological
take the psychological 4 hours
testing and written None
testing and written
entrance examination Medical Training Staff
entrance examination Entrance Examination:
2 hours
5. Endorsement of the 5. Submission of
applicants to the application by T.E.D to Medical Training Staff
None 24 hours
concerned Department Division concerned for
/ Division evaluation and interview
6. Initial recommendation
6. Waiting for final Concerned Department /
by concerned Division to None 1 wee
recommendtion Divisin
the T.E.D
6.1 Endorsement of
application by T.E.D to the
Deputy Executive Director
for E.T.R.S and to the Medical Training Staff
None 48 hours
Executive Director for
approval for respective
Residency or Fellowship
program
Notification by HRMD of
status of application and
7. Waiting for final Human Resource
other requirements and N/A N/A
recommendation Management Staff
procedures to the
applicant
11 days, 6 hours and 20
Total P900.00
minutes
End of Transaction
Hypertension and Lipid Clinic Enrolment

Adult patients who are obese or with hypertension and abnormal lipid profile are seen and managed with lifestyle modification or
pharmacotherapy.
Schedule of clinic is every Tuesday and Thursday between 8:30 am to 12:00 nn at Preventive Cardiology Division, 8/F Medical Arts
Building.

Office/Division: PREVENTIVE CARDIOLOGY DIVISION (PCD)/ CARDIOMETABOLIC SECTION

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: Adult Patients with either obesity, hypertension or abnormal lipid profile
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Appointment Slip or People’s Day Program – DAPA Hall

Referral from Attending Physician OPD Clinic, MAB Annex/ Community Clinic/ Private Clinic
FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
PAID TIME RESPONSIBLE
1. Register name and present 1. Receive and check None 10 minutes Science Research
requirements at Hypertension & Lipid requirements Specialist II
Clinic Desk, PCD Office 1.1. Conduct initial interview
and get demographic PCD Office, 8/F MAB
profile
1.2. Prepare assessment and
initial form
1.3. Instruct patient to submit
to screening tests
 FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
PAID TIME RESPONSIBLE
2. Submit to Screening Tests and 2. Perform screening tests None 25 minutes Science Research
nutrition counselling at Laboratory and nutrition counselling Specialist II and Science
Room, PCD Office 2.1. BP/ Heart Rate Research Specialist I and
2.2. Anthropometric Nutritionist/Dietitian
measurements
2.3. BMI/ waist and hips PCD Office, 8F MAB
2.4. FBS/ Cholesterol
2.5. ECG
2.6. Instruct patient to wait for
consultation
3. Proceed to Consultation Room 3. Get medical history and None 15 minutes 2nd and 3rd Year Adult
perform physical Cardiology Fellow
examination
3.1. Accomplish patient’s PCD Office, 8/F MAB
initial form
3.2. Issue laboratory request
and prescription
3.3. Give patient education
3.4. Prepare medical
certificate upon request
3.5. Admit patient with
Cardiovascular Disease
(CVD) risks to
Hypertension & Lipid
Clinic, or
3.6. Refer patient with CVD
to OPD Clinic and Social
Service or other
specialists
3.7. Instruct patient to
proceed to clinic desk for
further instructions
 FEES TO BE PROCESSING PERSON
CLIENT STEPS AGENCY ACTION
PAID TIME RESPONSIBLE
4. Receive final instructions 4. Clarify doctor’s advice on None 5 minutes Science Research
prescription and Specialist II
laboratory requests
4.1. Issue Client PCD Office, 8/F MAB
Satisfaction Survey
and appointment
card
5. Fill out Client Satisfaction Survey, 5. Give Information, None 5 minutes Science Research
receive appointment card and come Education and Specialist II
back on appointment date Communication (IEC)
materials on CVD risks PCD Office, 8/F MAB
Total None 1 hour

End of Transaction
Hypertension and Lipid Clinic
Follow-up visits of patients enrolled at Hypertension and Lipid Clinic every three (3) to six (6) months is done to ensure compliance to
lifestyle modifications and medical management.

Schedule of clinic is every Tuesday and Thursday between 8:30 am to 12:00 nn at Preventive Cardiology Division, 8/F Medical Arts Building.

Office/Division: PREVENTIVE CARDIOLOGY DIVISION (PCD)/ CARDIOMETABOLIC SECTION

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: Adult Patients enrolled at Hypertension and Lipid Clinic
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Appointment Card Hypertension & Lipid Clinic, PCD Office, 8/F MAB

Laboratory Results PHC Laboratory or other diagnostic center

FEES TO BE PROCESSING
CLIENT STEPS AGENCY ACTION PERSON RESPONSIBLE
PAID TIME
1. Proceed to Hypertension & 1. Prepare patient’s medical chart None 10 minutes Science Research
Lipid Clinic Desk, register 1.1. Fill-out assessment and follow- Specialist II or Science
name and present appointment up form Research Specialist I
card and laboratory results 1.2. Record laboratory results and get
BP monitoring sheet PCD Office, 8/F MAB
PCD Office, 8/F MAB
2. Submit to Laboratory Tests at 2. Perform screening tests and nutrition None 25 minutes Science Research
Laboratory Room, PCD Office counselling Specialist II and Science
1.1. BP/ Heart Rate Research Specialist I and
1.2. Anthropometric measurements Nutritionist/Dietitian
1.3. BMI/ waist and hips
1.4. FBS/ Cholesterol PCD Office, 8/F MAB
2.1. ECG (done once a year or upon
doctor’s advice)
3. Proceed to Consultation Room 3. Provide medical None 20 minutes 2nd and 3rd Year Adult
at PCD Office for physical examination and Cardiology Fellow
examination management
3.1. Instruct medications PCD Office, 8/F MAB
3.2. Give patient health education
3.3. Accomplish follow-up form
3.4. Prepare medical certificate
4. Receive final instructions and 4. Give exit interview None 5 minutes Science Research
schedule of next follow-up at 4.1. Clarify doctor’s advice Specialist II or Science
the Hypertension & Lipid 4.2. Explain doctor’s prescription and Research Specialist I
Clinic, PCD Office laboratory requests
4.3. Set schedule for next follow-up PCD Office, 8/F MAB

Total None 1 hour

End of Transaction
REQUEST FOR MEDICAL CERTIFICATE, CLINICAL ABSTRACT, DISCHARGE SUMMARY
Types of document usually required as proof of confinement or as supporting paper for financial assistance requests,
insurance claim and other purposes. The requested document/s will be reviewed by the doctor before they sign it.

OFFICE OF THE DIVISION: MEDICAL RECORDS SECTION

CLASSIFICATION: Complex
TYPE OF TRANSACTION G2C – Government to Citizen
WHO MAY AVAIL: Authorized Representative of Patient other than Immediate
Legal Family
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
For Patient
Request for Health Information Form Medical Records Office – near Window 16th
(FM-E-CRD-MLD-MRS- 2017-005 ) floor MAB Bldg.

Government Issued Identification Cards BIR, Post Office, DFA, PSA, SSS, GSIS,
(1 original copy and one photocopy with Pag-IBIG, OSCA, LTO, PhilHealth,
specimen signature) COMELEC, PRC, POEA

Queue Card Medical Records Office – near Window 1

Subpoena (1photocopy) patient issued by court / DOJ
-- if it will be used for Court /DOJ
For Representative
Letter of Authorization -- if next of kin is not available Person being represented
from Patient If married–spouse, children (18y/o and above
(1 original copy ) If single – parent, sibling
or Special Power of Attorney
(1 original copy) ( 1 photocopy)
Government Issued Identification Cards BIR, Post Office, DFA, PSA, SSS, GSIS,
of patient and representative Pag-IBIG, OSCA, LTO, PhilHealth,
(1 original copy and one photocopy with specimen COMELEC, PRC, POEA
signature)
Request for Health Information Form Medical Records Office – near Window 1
(FM-E-CRD-MLD-MRS- 2017-005 ) 6th floor MAB Bldg.
Queue Card Medical Records Office – near Window 1
Subpoena (photocopy) - if it will be used for Court patient issued by court / DOJ
or DOJ

PLEASE TAKE NOTE:

If patient’s data has some DISCREPANCY or
NEEDS SOME SUPPORTING DOCUMENTS
before processing the request, please provide one
(1) PHOTOCOPY and the original copy of the
document being requested for verification
Birth Certificate of patient– in case of some Philippine Statistics Authority (PSA)
discrepancy on
patient’s name,
date of birth, age,
father’s name,
mother’s maiden
name
Birth Certificate of representative PSA/ Local Civil Registrar
-- as proof of relationship
Passport or ACR ID / - Proof of citizenship DFA or other similar agency in country of
Certificate of Citizenship if patient is a origin / Bureau of Immigration
foreigner
1 photocopy- present original for verification
Marriage Certificate or- for patient’s status Philippine Statistics Authority (PSA)
(single to married)

Certificate of No Marriage) --for status

(CENOMAR)(married to single)
Death Certificate of spouse, --as proof of death PSA / Local Civil Registrar
parents, siblings ( next of kin)

Social Case Study Report/ Adoption papers DSWD near your residence

Sworn Statement– in some cases, when there is a Law Office

need to support the statement /
claim of patient’s representative

CLIENT STEPS AGENCY ACTION FEES PROCESSI PERSON

TO BE PAID NG TIME RESPON
SIBLE
1. Present the 1. Interview the patient None DAY 1 Medical
properly /relative to check the 15 minutes Records
accomplished legality and check the Officer or
Request Form, completeness of the Clerk IV
requirements accomplished Request
and Queue Card Form.
to ROI Windows
and receive claim
slip

* Failure to properly 1.1 Explain processing MC (Medical

accomplish the time and fees. Certificate)
Request Form will Pay 100
Service P50
cause delay in the
CA (Clinical
processing of your 1.2. Advise to bring the Abstract) &
request. Lacking DS (Discharge
* Please take requirements and Summary)
note of the issue claim slip. Pay P50
reminder Service P25
regarding AUTHENTICATION
A1. Discharge
additional Summary /
requirements Clinical
on special cases Abstract
(see above) /Certificate
P10.00
per page

A2. Test
Results
P 3.00
per page

B.PHOTOCOPY
P3.00 per page
C. INSURANCE
P200
TOTAL FEES=
MC+CA/DS+A1+A2+
B+C
2. Follow-up your 2. Trace and retrieve the None DAY 2 to 3 Reproduct
request patient’s medical record. ion
/call 8925-2401 Machine
Local 3618 2.1. Line-up the record with Operator
request for processing. None /Laborator
y Aide
File according to date of
request.

2.2 Prepare the requested None DAY 2 TO 3 Medical

document/s. Records
45minutes Officer
orClerk IV
2.3. Register to MR tracking None DAY 2 TO 3 Medical
system. Records
5 minutes Officer
orClerk IV
2.4. Transport the None DAY 4 TO 5 Reproduct
documents to ion
the clinic or assigned 10minutes Machine
areas of the doctor. Operator
/Laborator
y Aide

2.5. Have the doctor review None DAY 4 TO 5 Reproduct

and sign the ion
documents 16 HOURS Machine
Operator
/Laborator
y Aide
 2.6. Update the status in None Day 5 Medical
Tracking once the Records
documents are signed 5minutes Officer
orClerk IV
2.7. File the assigned None Day 5 Reproduct
documents ion
according to date of 5 minutes Machine
request. Operator
/Laborator
y Aid

3. Get a queue card 3. Check the completeness None Day 6

and present the claim of lacking requirement/s (Day of
slip, and other lacking and accomplish the Claiming)
requirements at the order of payment
ROI Windows 1 & 2 portion of the claim slip.
4. Pay applicable fees 4. Prepare the photocopy / MC (Medical Day 6 Medical
at the Cashier’s authenticates Certificate) Records
Office (Basement documents Pay 100 Officer or
8am-5pm; or Service P50 20 minutes Clerk IV
CA (Clinical
4/F -10am-5 pm)
Abstract) &
DS (Discharge
Summary)
Pay P50
Service P25
AUTHENTICATION
A1. Discharge
Summary /
Clinical
Abstract
/Certificate
P10.00
per page

A2. Test
Results
P 3.00 x no.of
copies

B.PHOTOCOPY
P3.00 x no. of copies
C. INSURANCE
P200
TOTAL FEES=
MC+CA/DS+A1+A
2+B+C
5. Present official 5. Receive OR, record None 5 minutes Medical
receipt and receives transaction and Records
documents release the documents Officer or
requested Clerk IV

TOTAL: TOTAL FEES= 6 days

MC+CA/DS+A1+
A2+B+C
 END OF TRANSACTION
REQUEST FOR PHOTOCOPIES & AUTHENTICATION OF CLINICAL ABSTRACT, DISCHARGE SUMMARY,
OPERATING ROOM RECORD, DEATH CERTIFICATE, DIAGNOSTIC /LABORATORY TEST RESULTS
(for requests made by patient or immediate legal family)

Request for plain photocopies and/or certified true copies of the above medical records are usually required by other
healthcare professionals for continuous patient care, in seeking financial assistance, support for insurance claims and
other purposes.
OFFICE OF THE DIVISION: MEDICAL RECORDS SECTION

CLASSIFICATION: Simple
TYPE OF TRANSACTION G2C – Government to Citizen
WHO MAY AVAIL: Patient or Immediate Legal Family

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

For Patient

Request for Health Information Form Medical Records Office – near

(FM-E-CRD-MLD-MRS- 2017-005 ) Window 16th floor MAB Bldg.

Government Issued Identification Cards BIR, Post Office, DFA, PSA, SSS,
(1 original copy and one photocopy with specimen signature) GSIS, Pag-IBIG, OSCA, LTO,
PhilHealth, COMELEC, PRC,
POEA
Queue Card Medical Records Office – near
Window 1
Subpoena (1photocopy) -- if it will be used for Court patient issued by court/DOJ
For Immediate Legal Family Members
Letter of Authorization from Patient (1 original copy ) Patient
Queue Card Medical Records Office
– near Window 1
Government Issued Identification Cards of patient and BIR, Post Office, DFA, PSA, SSS,
representative GSIS, Pag-IBIG, OSCA, LTO,
(1 original copy and one photocopy with specimen signature) PhilHealth, COMELEC, PRC,
POEA
Request for Health Information Form Medical Records Office
(FM-E-CRD-MLD-MRS- 2017-005) – near Window 1

Subpoena -- if it will be used for Court/DOJ Patient/ Relative issued by court /

DOJ

PLEASE TAKE NOTE:

If patient’s data has some DISCREPANCY or NEEDS
SOME SUPPORTING DOCUMENTS before processing the
request, please provide one (1) PHOTOCOPY and the
original copy of the document being requested for
authentication
Barangay Certificates -- In case of change or Barangay or Municipal Hall
additional address

Birth Certificate of patient– in case of some discrepancy Philippine Statistics Authority (PSA)
on patient’sname, date of
birth, age, father’s name,
mother’s maiden name

Birth Certificate of representative -- as proof of relationship PSA/ Local Civil Registrar

Marriage Certificate or -- for patient’s status (single to Philippine Statistics Authority (PSA)
married)
(Certificate of No Marriage) -- for status(married to single)
(CENOMAR)
Death Certificate of spouse, --as proof of death PSA / Local Civil Registrar
parents, siblings ( next of kin)

Passport or Alien Certificate- Proof of citizenship if patient DFA or other similar agency in
Registration (ACR) ID is a foreigner country of origin / Bureau of
Certificate of Citizenship Immigration
(1 photocopy - original to be presented for verification)
Social Case Study Report/ Adoption papers DSWD near your residence

Sworn Statement– in some cases, when there is a Law Office

need to support the statement
/claim of patient’s representative

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON

TO BE PAID TIME RESPONSIBLE

1. Present the properly 1. Interview the patient None 5 minutes Medical

Accomplished Request /relative to check the Records Officer
Form, requirements legality and check or
and Queue Card to completeness of the Clerk IV
any ROI Window accomplished
when called. Request Form.
* Failure to accomplish
properly the Request Form
may cause delay in the
processing of request.
* Please take note of the
reminder regarding
additional requirements
on special cases
(see above)
2. Wait for the availability 2. Retrieve patient’s None 20 minutes Reproduction
of medical record and medical record. Machine
release of claim slip Operator III or
with order of payment Laboratory Aide
II
at ROI counter.

3 Receive the Claim Slip 3. Computes the None 5 minutes Medical

with Order for Payment amount of fees to Records Officer
be paid and issue or
claim slip with Clerk IV
order of payment

4. Pay applicable fees 4. Photocopy the AUTHENTICATI 15 minutes Reproduction

requested medical ON Machine
for photocopying
A1. Discharge Operator
and authentication at records. Summary / /Laboratory
the Cashier’s Office Clinical
Aide
(Basement 8am-5pm; Abstract/Certific
or ate
P10.00 per
4/F -10am-5 pm) page Medical
4.1 Authenticate the A2. Test Records Officer
requested Results or
documents. P 3.00 per page Clerk IV
B.
PHOTOCOPY
P3.00 per page
 5. Present the original 5. Receives the OR None 5 minutes Medical
Official Receipt and release the Records Officer
requested or
documents. Clerk IV

5.1. Document the

transaction
TOTAL A1= 50 minutes
P10 x no.of
copies

A2=
P3.00 x no.of
copies

B=
P3.00 x no.of
copies
TOTAL
=A1+A2+B

END OF TRANSACTION

REQUEST FOR PHOTOCOPIES & AUTHENTICATION OF CLINICAL ABSTRACT, DISCHARGE SUMMARY,

OPERATING ROOM RECORD, DEATH CERTIFICATE, DIAGNOSTIC /LABORATORY TEST RESULTS
(for requests made by authorized representative other than patient or immediate legal family)

Request for plain photocopies and/or certified true copies of the above medical records are usually required by other
healthcare professionals for continuous patient care, in seeking financial assistance, support for insurance claims and
other purposes.
OFFICE OF THE DIVISION: MEDICAL RECORDS SECTION
CLASSIFICATION: Simple
TYPE OF TRANSACTION G2C – Government to Citizen
WHO MAY AVAIL: Authorized representative of patient other than
immediate legal family
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
For Representative
Letter of Authorization --- if the patient cannot sign Person being represented
or Special Power of Attorney or the next of kin is not If married–spouse, children
one (1) original copy available. (18y/o and above
and one (1) photocopy If single – parent, sibling

Government Issued Identification Cards of patient Government Issued Identification

and representative Cards of patient and representative
(1 original copy and one photocopy with specimen (1 original copy and one photocopy
signature) with specimen signature)

Request for Health Information Form Medical Records Office

(FM-E-CRD-MLD-MRS- 2017-005) – near Window 1
Queue Card Medical Records Office
– near Window 1
Subpoena-- if it will be used for Court/DOJ From Patient issued by court / DOJ
PLEASE TAKE NOTE:
If patient’s data has some DISCREPANCY or NEEDS
SOME SUPPORTING DOCUMENTS before processing
the request, please provide one (1) PHOTOCOPY and
the original copy of the document being requested for
authentication

Affidavit of Loss -- In case of loss of Notary Public

document

Barangay Certificate-- In case of change or Barangay or Municipal Hall

additional address

Birth Certificate of patient– in case of some Philippine Statistics Authority (PSA)

discrepancy on patient’s
name, date of birth, age,
father’s name,
mother’s maiden name

Birth Certificate of representative PSA/ Local Civil Registrar

-- as proof of relationship
Marriage Certificate or- for patient’s status Philippine Statistics Authority (PSA)
(single to married)
CENOMAR - for status
(Certificate of No Marriage)(married to single)

Death Certificate of spouse, parents, siblings PSA / Local Civil Registrar

-as proof of death ( next of kin)

Passport or ACR ID / - Proof of citizenship if DFA or other similar agency in country

Certificate of Citizenship patient is a foreigner of origin / Bureau of Immigration
(1 photocopy - original to be presented for verification)

Social Case Study Report/ Adoption papers DSWD near your residence
Sworn Statement– in some cases, when there Law Office
is a need to support the
statement /claim of
patient’s representative

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON

TO BE TIME RESPONSIBL
PAID E
1. Present the properly 1. Interview the authorized none 5 minutes Medical
Accomplished representative to check the Records
Request Form, legality of request and Officer or
requirements and check Clerk IV
Queue Card to any completeness of the
ROI Windows accomplished Request
when called. Form.
1.1. Advise regarding the
* Failure to accomplish lacking requirements
properly the Request and issue a claim slip.
Form may cause
delay in the
processing of request.

* Please take note

of the reminder
regarding
additional
requirements
on special cases
(see above)
2. Present lacking 2. Receive pending None 5 minutes Medical
requirements and requirements Records
receive updated claim Officer or
slip with order of Clerk IV
payment to any
ROI Window

2.1. Retrieve patient’s None 20minutes Reproduction

medical record Machine
Operator III
or
Laboratory
Aide II
 2.2 Computes the none 5 minutes Medical
amount of fees to Records
be paid and Officer or
accomplishes order Clerk IV
of
payment part of
claim
slip

3. Pay applicable fees 3. Photocopy the AUTHENTI 15 minutes Reproduction

requested medical CATION Machine
for photocopying
A1. Operator
and authentication at records. Discharge /Laboratory
the Cashier’s Office Summary
Aide
(Basement /
8am-5pm; Clinical
Abstract
or
4/F -10am-5 pm) 3.1 Authenticate the /Certificate
requested P10.00 Medical
documents. per page Records
Officer or
A2. Test Clerk IV
Results
P 3.00
per page

B.
PHOTOCO
PY
P3.00 per
page
4. Present the OR and 4. Receive the OR and None 5 minutes Medical
receive the release the requested Records
requested documents. Officer or
document/s at Clerk IV
ROI Window 4.1. Document the
transaction
TOTAL A1= 55 MINUTES
P10 x no.
of copies

A2=
P3.00 x
no. of
copies

B=
P3.00 x
no.of
copies
TOTAL
=A1+A2+
B

END OF TRANSACTION
REQUEST FOR RESEARCH OF INPATIENT STATISTICAL DATA AND VARIOUS CASES / DIAGNOSES
(For requests made by external clients)

This service is a request for acquiring and gathering of different statistical data / information and census of various cases or
diagnoses of inpatients being used for their research, feasibility study and thesis requirement. The main clients mostly are the
students and researchers of different schools and private companies and hospitals for personal / company growth and quality
development which are potentially valuable. The release of every data is with consideration to Data Privacy Act (DPA) known as
Republic Act No. 10173. The data being gathered may not be the typical data being gathered for internal clients (in-hospital use)
and may require a longer period and additional research to be prepared.

OFFICE OR MEDICAL RECORDS SECTION

DIVISION:
CLASSIFICATION: Highly Technical
TYPE OF G2B – Government to Business
TRANSACTION: G2C - Government to Citizen

Researchers/ Students - Colleges and Universities; Private Companies &

WHO MAY AVAIL: Hospitals
WHERE TO SECURE
CHECKLIST OF REQUIREMENTS
1. School ID / Company ID Personal

2. Endorsement Letter from School / Agency addressed either School / Agency of the one Requesting
to the PHC Executive Director or Deputy Executive Director
(DED) thru Department Manager of Education Training &
Research Services (ETRS)
Medical Records Section (MRS) Office, 6/f
3. Request for Patient's Chart Form(FM-E-CRD-MLD-MRS- MAB
2017-007)

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON

TO BE TIME RESPONSIBLE
PAID
1. Present valid ID 1. Check valid ID then receive none Day 1 20 Librarian III –
and properly filled out Endorsement Letter minutes In-charge of
Request for Patient's 1.1 Check the availability and Statistics
Chart Form. Submit feasibility of data
Endorsement Letter 1.2 Check the approval notation from
at MRS Office the PHC Executive Director or ETRS
(Most of the time, the Deputy Executive Director thru
researcher comes Department Manager. (If it does not
along with an have yet an approval then instruct
Endorsement Letter researcher to go to the 2nd floor,
addressed either to Executive Offices, MAB.
the PHC Executive
Director or DED of
ETRS)
2. Ask for 2. Receive Endorsement Letter and none Day 1 Executive
endorsement from the interview the researcher 25 minutes Director /
PHC Executive 2.1 Mark notation on the letter and Deputy
Director or Deputy advise to give it back to the Medical Executive
Executive Director Records Section Director of
thru Dept. Manager of 2.2 Or in the absence of ETRS thru
ETRS at 2/f, signatories – leave the Endorsement Dept
Executive Offices letter at Director's Office / DED Manager /
Clerk
3. Wait for any call / 3. Receive approved Endorsement none Day 2 Chief
text, if any Letter from the Clerk, 20 minutes Administrativ
e Officer /
3.1 Review and mark notation on Medical
the Endorsement Letter, if any Records
Officer III /
3.2. Approve and sign the said Clerk
letter;

3.3 Call/ text researcher, if

needed
3.4 Advise Clerk to return to In-
charge of Request – Librarian III
4. Wait for the 4. Receive, review and mark notation none Day 2 Librarian III
processing of request on the Endorsement Letter. 30 minutes

4.1 Advise follow up after 5 to 7

days depends on the complexity of
the request and explain the process of
gathering data

4.2 Record the transaction in the log

book.
5. Wait and follow up 5. Start processing the request: none Day 3 Librarian III
for the request to be 5.1 Check if data on files exists / 4 hours
processed update;
5.2 Search each requested cases / Day 4 - 7
diagnoses or the complications of 32 hours
each diseasesfrom International
Statistical Classification of Diseases
& Related Health Problems Book
with 3 volumes and get the
corresponding ICD 10 codes; Check
Medical Dictionary for any medical
terminologists that are rare and hard
to understand; Ask the advise of a
Physician for the accuracy of data, if
needed.
 5.3 Extract needed data through Day 8-10 Librarian III –
different programs from Medtrak 24 hours In-charge of
Dbase System Statistics

5.3.1 Enter ICD 10 code each for

different Cases/Diseases / Diagnosis
and enter corresponding years
depends on the capability of the
search engine of Medtrak (various
requested data are for over ten years,
the most)

5.3.2 Export raw data gathered and

convert into excel;

5.3.3 Extract again other data

according to their request and
corresponding years
5. Wait and follow up 5.4 The process of gathering data Day 11 – 13 Librarian III
for the request to be extracted from Medtrak Dbase is 24 hours
processed CONT. repeatedly done until all needed data
will be completed.
5.5 Repeat exporting raw data and Day 14 - 16 Librarian III
convert into excel until done, such as: 24 hours
5.5.1 Identify diseases which are
the subject of their study

5.6 Sort out, identify, pivot, arrange, Day 17 -18 Librarian III
count statistically in a particular order 16 hours
all data;
5.7 Check and analyze data Day 19 Librarian III
organization; check its completeness 8 hours
& accuracy.
5.8 Print data. Day 19 Librarian III
20 min
 6. Get order of 6. Issue order of payment and none Day 20 Librarian III
payment from MRS instruct to pay at the Cashier Office (10 minutes)
Office
7. Present order of 7. Receive payment and issue Php. 800.00 Day 20 Cashier 's
payment and pay the official receipt (30 minutes) clerk
applicable amount at
Cashier, (4/f, 10 am –
5 pm or in the
Basement, 8 am – 5
pm)
8. Submit the official 8. Receive the official receipt and none Day 20 Librarian III
receipt, receive the record the transaction in the logbook (10 minutes)
requested data then then release the same to
sign in the logbook at
researcher.
MRS Office

TOTAL Php. 800.00 20 days

END OF TRANSACTION

REQUEST FOR VARIOUS STATISTICAL DATA ON HOSPITAL DISCHARGES - (GOVERNMENT AGENCY)

This service is a request for acquiring and gathering of different statistical data / information and census on various cases or
diagnoses of discharged patients usually with inclusive years requested directly by the policy making bodies for any
appropriate intervention action, disease surveillance, public health planning, for programs / activities to be launched and
mandatory statistical data reports which form part also of the annual report and other health purposes. The release of every data is
with consideration to Data Privacy Act (DPA) known as Republic Act No. 10173.

OFFICE OR MEDICAL RECORDS SECTION

DIVISION:
CLASSIFICATION: Highly Technical
TYPE OF G2G – Government to Government
TRANSACTION:
Liaison Officers, Researchers, Staff - Government Agencies and other Accredited
WHO MAY AVAIL: Institutions of Government Entities

WHERE TO SECURE
CHECKLIST OF REQUIREMENTS
1. Agency ID Requesting Agency

2. Government Agencies and other Accredited Institutions of

Government entities)

2.1 Endorsement Letter / Memorandum (if any) addressed either

to the PHC Executive Director or Deputy Executive Director (DED)
thru Department Manager of Education, Training & Research
Services (ETRS)
 CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON
TO BE TIME RESPONSIBLE
PAID
1. Present valid ID 1. Receive and review Endorsement none Day 1 30 Chief
and submit Letter / Memorandum minutes Administrative
Endorsement Letter / 1.1 Check the availability and Officer
Memorandum, if any, feasibility of data; (i.e. Census over /Medical
10 years or inclusive years, with Records
to Medical Records
combination of various cases; Officer III/
Section (MRS) Office Librarian III
demographic data; itemized as pedia
or adult patients with corresponding
age and gender)
1.2 Check the approval notation from
the PHC Executive Director or Deputy
Executive Director (DED) thru
Department Manager of ETRS . If it
does not have yet an approval then
instruct Liaison Officer to go to the
2nd floor, Executive Offices, MAB
2. Ask for 2. Receive Endorsement Letter and none Day 1 Executive
endorsement for the interview Liaison Officer 15 minutes Director /
PHC Executive DED thru
Director or Deputy 2.1 Mark notation and advise to Dept
Executive Director give it back to MRS Office Manager of
(DED) of ETRS, 2/f 2.2 Or If the signatories not ETRS /
Executive Offices available - advise Liaison Officer to Clerk
leave Endorsement Letter in the
Director's Office / DED and or Dept.
Manager at ETRS Office for
approval notation
3. Wait for any call 3. Receive Endorsement Letter / none Day 2 Clerk /
/text message from Memorandum from the clerk 30 minutes Librarian III
Librarian III
3.1 Call / Text and inform
concerned Liaison Officer about the
request, then advise to follow up
after 4 to 6 days depends on
complexity of request and explain
the process of gathering data and
its difficulty of retrieving different
data/information.

3.2 Mark notation.

3.3 Record the transaction in the

log book.
4. Wait and follow up 4. Start processing the request: none Day 3 Librarian III
for the request to be 8 hours
processed 4.1 Check if data on files exists /
update
4.2 Search each requested cases / Day 4-6 Librarian III
diagnoses or the complications of 24 hours
each diseasesfrom International
Statistical Classification of Diseases
& Related Health Problems Book
with 3 volumes and get the
corresponding ICD 10 codes; Check
Medical Dictionary for any medical
terminologists that are rare and hard
to understand; Ask also a Physician
for the accuracy of data, if needed.
 4.3 Use different programs and none Day 7-9 Librarian III
extract needed data through 24 hours
Medtrak Dbase System

4.3.1 Enter ICD 10 code each for

different Cases/Diseases /
Diagnosis and enter
corresponding years depends on
the capability of the search engine
of Medtrak (various requested data
are for over ten years, the most)

4.3.2 Export raw data gathered and

convert into excel;

4.3.3 Extract other needed

data according to corresponding
years and Philhealth data for each
patient / if no data of Philhealth,
Listings of Patients with no records
will be forwarded to Billing Section
for completeness of record.
4.3.3.1 Receive Listings of Patients
from Billing Section

4.3.4 The process of gathering data

extracted from Medtrak Dbase is
repeatedly done until all needed
data will be completed.
4. Wait and follow up 4.4 Repeat exporting raw data and Day 10 - 12 Librarian III
for the request to be convert into excel until done, such as: 24 hours
processed CONT.
4.4.1 Check treatment given to
each patient if Surgery or Medical
and itemize with their Categories as
Pay & Service
4.4.2 Identify catchment areas
wherein services for patients with
particular cases are provided.
4.4.3 Sort between pedia and
adult patients and its gender
4.4.4 Percentage rate for
Morbidity and Mortality
4.4.5 Itemize the result of
treatment for each patients as
Improve, Diagnosis only, Transfer,
Recovered and Died.
4.5 Sort out, identify, pivot, arrange, none Day 13-15 Librarian III
count statistically in a particular order 24 hours
all data;

4.6 Check and analyze data Day 16-18 Librarian III

organization; check its completeness & 24 hours
accuracy.
4.7 Print data Day 19
8 hours
5. Receive the 5. Record the transaction in the none Day 20 Librarian III /
requested data then sign logbook then release the same to 15 minutes) Clerk
in the logbook. Liaison Officer / clerk.

TOTAL none 20 days

END OF TRANSACTION
RECEIVING OF SUBPOENA
The Medical Records Section is also receiving Subpoena either for litigation or investigation purposes, for some cases
wherein the Chief or Records Officer is required to bring the patient’s medical record to Court or to the Department of
Justice and to testify as Records Custodian.

OFFICE OF THE DIVISION: MEDICAL RECORDS SECTION

CLASSIFICATION: Simple
TYPE OF TRANSACTION G2G – Government to Government

WHO MAY AVAIL: NBI, RTC, PRC

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Subpoena addressed to Chief of Medical Library Court / Department of Justice
Division or Medical Records Officer

Contact Number of RTC

CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON

TO BE TIME RESPONSIBL
PAID E
Present the Subpoena 1. Read the Subpoena , None Day 1
issued by Court date of hearing and -- Medical
addressed to Chief / other details. Records
Medical Records 1.1 Have the Court 5 minutes Officer
Officer. Representative --- Secretary
be seated while
checking the
name of patient.
1.2 Check the Master
Patients Index or
EMR.

2. Take back the 2.Receive the Subpoena None

Receiving copy of addressed to Chief of 5 minutes Medical
the Division /Medical Records
the Subpoena Officer
Records Officer.
and return to RTC
2.1 Indicate the following:
Office/DOJ. - printed name
Secretary
- time & date of receipt
- contact no. of the
Court /DOJ and
/name of their
representative
.

TOTAL None 30minutes

END OF TRANSACTION
OTHER ACTIONS AFTER None DAY 2 TO 5 Medical
RECEIVING THE Records
SUBPOENA Officer

Secretary
*Retrieve the medical
record and check for
other loose records/
test results.

* Refer to Legal
Office/ Director for
approval.
* Prepare a Request for
vehicle

* Bring the subpoenaed DAY OF -- Chief

Medical records on HEARING -- Medical
the day of hearing. Records
Officer

PHILIPPINE HEART CENTER

MEDICAL RECORDS AND LIBRARY

RATES – AUGUST 1, 2018

 Local Foreign
1. Medical Certificate
Pay patient P 100.00 *
Service patient 50.00 *

2. Clinical Abstract (CA)

Pay patient 50.00 *
Service patient 25.00 *

3. Authentication Fee - Pay patient/Service patient

Medical Certificate/Clinical Abstract/ P 10.00/page
Discharge Summary/Certificate of Confinement

Diagnostic & Laboratory Test Results/

Operating Room Record 3.00/page
Pay patient/Service patient

4. Health Information Insurance 200.00

Purposes (SSS,GSIS, etc.)

5. Verification Fees from Insurance Co., etc. P 100.00 $ 6.00

6. Requests of Statistical Data, Research & 800.00

Case Study by Students/Outsiders

7. Foreign Requests for patient's Medical Records $ 15.00

8. Photocopying Fees
Long/Short 3.00/page
PHC Employees 2.50/page

* Effective January 1, 2019

Non-PHC-Funded Protocol (1-2 site)
All approved research protocol from other Institution to be conducted to Philippine Heart Center will be forwarded by Clinical
Trial and Research Division for ethics review approval/ethical clearance.

Office/Division: Institutional Ethics Review Board

Classification: Highly Technical
Type of G2G to G2C: Government to Government; Government to Citizens
Transaction:
Who may avail: From other Institution to be conducted to Philippine Heart Center
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
A. Initial Review

1. Protocol package (1 original, 10 - Principal Investigator/Clinical Trial and Research Division (CTRD) Staff
photocopies)
2. Consent Form (ICF) English and
Filipino Version or Waiver of Written
Informed Consent Form (For Adult).
3. Assent Form and Parent
Information/Informed Consent Form
English and Filipino version –
Pediatric Patient or Waiver of Written
Informed Consent Form
a. Verbal Assent (7-12 y/o)
b. Simplified Assent (12-15 y/o)
c. Co-sign with parents/Legally
Authorized Representative for
ICF- 15-18 y/o)
4. Curriculum Vitae and Good Clinical
Practice Certificate of Primary and
Sub-Investigator
 5. Budget Proposal
6. Research Protocol Approval Form
7. Filled out Initial application form and
document receipt
8. Official Receipt (O.R.) or letter
approved to waive fees
B. Resubmission
1. One (1) copy of revised protocol - PI
package
C. Continuing Review Requirements
1. Filled out Continuing Review Form - PI
2. If with changes by the Principal
Investigator
- One (1) copy of revised
protocol and ICF
- Original copy of protocol with
highlights of changes
- Amendment application form
D. Early Study Termination
1. Filled out Study termination form - PI
2. Requesting to terminate
E. Final Study
1. Filled out final study report form - PI
2. One (1) copy of completed paper with
an abstract
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
A. Initial Review
1. Submit 1..Check requirements, None 14 days IERB Staff
requirements stamp "received"
(IERB Office and sign the
document receipt
8/F MAB)
form.
 1.1 Receive 1.2 Sign CTRD
statement of receiving copy
logbook.
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
account for 1.1 Record and Designated reviewers
Institutional encode protocol
Fee and assign
IERB number.
(CTRD 1.2 Prepare receipt
office 9/F and assessment
MAB) form of protocol
package and
distribute to
designated
members for
review.
1.3 File the original
protocol
package.
1.4 Include in the
agenda of the
next IERB
meeting.
1.5 Issue statement
of account.
1.6 Instruct to
request
statement of
account to
CTRD and wait
for date of
presentation.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Pay applicable 2..Receive payment P 40,000.00 20 minutes Cashier
fees and issue official P 100,000.00
(Cashier- receipt
Basement,
hospital building
ground floor)
make sure to get
official receipt
3. Present official 3..Photocopy official None 10 minutes IERB Staff
receipt to IERB receipt, stamp
(8/F MAB) and to received and file
CTRD (9/F MAB) 3.1 Return original
copy
3.2 Instruct to wait
for SMS
notification of
the date of
presentation.
3.3 Instruct to
present the
original receipt
of Institutional
Fee to CTRD.
4. Come back 4. Evaluate the None 1 day Designated Reviewer
to IERB office protocol/documents
for presentation (Scientific and
of protocol Informed consent
form) Primary/Designated Reviewer
3.1 Summarize the
 findings Board Secretary
3.2 Record the
decision of
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
IERB and
instruct client to
wait for any
modifications
5. Prepare decision None 5 days IERB Staff
and send to PI
5.1 File the
receiving copy

Total None 20 days

B. Resubmission
1..Submit one (1) 1..Receive, check and None 14 days IERB Staff
copy of revised stamp “RECEIVED”
protocol package revised protocol
package.
1.1 Notify and
distribute
protocol package
to chair and
designated
reviewer.
1.2 Include in the
agenda of the
next meeting
2..Present and review None 1 day Designated reviewer
protocol in an en
banc meeting Board Secretary
2.1 Record
decision
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3..Prepare decision None 5 days IERB Staff
and send to PI
3.1 File the
receiving copy

Total None days

C. Continuing Review Schedule (2 months before expiration of approval)
1..Wait for notice of 1. Check and track the None 1 day IERB Staff
schedule of dates of approved
continuing protocols
review 1.1 Send reminder
letter to PI
1.2 Remind to
submit progress
report or final
study report two
months before
the due date
2. Submit filled-out 2..Check for None 1 hour IERB Staff
continuing completeness of
review form and continuing review
progress report. form and progress
report.
2.1 Stamp
“RECEIVED”
2.2 Include in the
agenda of the
next meeting
 2.3 Instruct to wait
for schedule of
the next
meeting and
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
result of
deliberation
3. Pay applicable 3..Receive payment P 10,000.00 20 minutes Cashier
fees and and issue official
photocopy receipt
official receipt
(Cashier-
Basement MAB)
4. Present official 4..Check official None 5 minutes IERB Staff
receipt and receipt, receive and
submit file photocopy
photocopy of 4.1 Instruct to wait 14 days
official receipt for schedule of
(IERB office) the next meeting
and result of
deliberation
5. Wait for the 5. Deliberate and None 1 day IERB Board Members
result of the arrive at a decision. Board Secretary
deliberation 5.1 Record the
(PI study site) decision.
6. Receive decision 6..Prepare and send None 5 days IERB Staff
handed decision to PI
personally to PI 6.1 File the
study site by receiving copy
IERB staff and
sign receiving
copy.
 Total P 10,000.00 days

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
D. Early Study Termination
1. Submit Early 1..Receive and verify None 30 minutes IERB Staff
study termination study termination
form and letter form and letter
requesting to requesting to
terminate the terminate the study
study 1.1 Include in the agenda
(study is of the next meeting,
terminated upon review and archive. 14 days
receipt of the
letter, no need to
wait for next
IERB meeting)

Total None 14 days

E. Final Study Report
1. Submit filled out 1..Receive and stamp None 30 minutes IERB Staff
final study report filled-out final study
form and one (1) report form and
copy of copy of completed
completed paper paper.
(make sure to 1.1 Include in the
get agenda of the
acknowledgeme next meeting.
nt receipt.
2. Present, deliberate None 14 days Designated Reviewer
and archive final IERB Board
study report.
Total None 14 days
Non-PHC-Funded Protocol (3 or more site)
All approved research protocol from other Institution to be conducted to Philippine Heart Center will be forwarded by Clinical
Trial and Research Division for ethics review approval/ethical clearance.

Office/Division: Institutional Ethics Review Board

Classification: Highly Technical
Type of Transaction: G2G to G2C: Government to Government; Government to Citizens
Who may avail: From other Institution to be conducted to Philippine Heart Center
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
A. Initial Review

1. Protocol package (1 original, 4 - PI/CTRD staff/Study Coordinator

photocopies)
2. Informed Consent Form (ICF) English
and Filipino version
3. Letter of request for protocol review
4. Philippine Food Drug Administration
(PFDA) approval
5. Curriculum Vitae and Good Clinical
Practice Certificate of Primary and
Sub-Investigator
6. Certificate of Insurance
7. Filled out initial application form and
document receipt
8. Letter of intent addressed to Chair and
CTRD head
9. Official Receipt (O.R.) or letter
approved to waive fees
B. Resubmission
1. One (1) copy of revised protocol - PI/Study Coordinator
package
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
C. Continuing Review Requirements
1. Filled out Continuing Review Form - PI/Study Coordinator
2. If with changes by the Principal
Investigator
- One (1) copy of revised protocol and
ICF
- Original copy of protocol with
highlights of changes
- Amendment application form
D. Early Study Termination
1. Filled out Study termination form - PI/Study Coordinator
2. Letter requesting to terminate
E. Final Study
1. Filled out final study report form - PI/Study Coordinator
2. One (1) copy of completed paper with
an abstract
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
A. Initial Review
1. Submit 1..Check None 14 days IERB Staff
requirements and requirements,
receive statement stamp "received"
and sign the
of account for
document receipt
Ethics review fee form.
1.1 Provide a copy
IERB Office (8/F
of document
MAB) receipt form to
PI/study
1.1 Receive
coordinator.
statement of 1.2 Sign CTRD
account for receiving copy
logbook.
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
Institutional 1.3 Record and
Fee encode
protocol and
(CTRD office assign IERB
9/F MAB) number.
1.4 Prepare receipt
1.2 Submit and
electronic assessment
copy to Single form of protocol
package and
Joint Ethics
distribute to
Board office designated
(DOH, San members for
Lazaro review.
Compound 1.5 File the original
Manila) protocol
package.
1.6 Include in the
agenda of the
next IERB
meeting.
1.7 Issue
statement of
account.
1.8 Instruct to
request
statement of
account to
CTRD.
1.9 Instruct to
submit
electronic copy
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
of protocol
package to
SJREB and
wait for date of
presentation.
2. Pay applicable 2..Receive payment P 40,000.00 20 minutes Cashier
fees and issue official P 100,000.00
(Cashier- receipt
Basement,
hospital building
ground floor)
make sure to get
official receipt
3. Present official 3..Photocopy official None 10 minutes IERB Staff
receipt to IERB receipt, stamp
(8/F MAB) and to received and file
CTRD (9/F MAB) 3.1 Return original
copy
3.2 Instruct to wait
for SMS
notification of
the date of
presentation.
3.3 Instruct to
present the
original receipt
of Institutional
Fee to CTRD.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4. Come back to 4. Evaluate the None 1 day Designated Reviewer
IERB office for protocol/documents
presentation of (Scientific and
protocol Informed consent
4.1 Present the form) Primary/Designated
protocol in 4.1 Summarize the Reviewer
SJREB findings
meeting 4.2 Record the Board Secretary
decision of
IERB and
instruct client to
forward the
recommendatio
n to SJREB
and wait for
review meeting
to present the
protocol in
SJREB office.
5..Prepare decision None 5 days IERB Staff
and send to
SJREB.
1.1 File the
assessment
form.

Total P 140,000.00 20 days

 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
B. Resubmission (Site Specific Concern)
1..Submit one (1) 1..Receive, check and None 14 days IERB Staff
copy of approved stamp “RECEIVED”
protocol package approved protocol
by SJREB package.
1.1 Notify and
distribute
protocol
package to chair
and designated
reviewer.
1.2 Include in the
agenda of the
next meeting
2..Present and check if None 1 day IERB Board Members
compliance with site
specific concern in
an en banc meeting Board Secretary
2.1 Record decision

3..Prepare decision None 5 days IERB Staff

and send to PI
3.1 File the
receiving copy

Total None 20 days

 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
C. Continuing Review Schedule (2 months before expiration of approval)
1. Wait for notice of 1. Check and track the None 1 day IERB Staff
schedule of dates of approved
continuing review protocols
1.1 Send reminder
letter to PI with
statement of
accounts
1.2 Remind to
submit progress
report or final
study report two
months before
the due date
2. Submit filled-out 2..Check for None 1 hour IERB Staff
continuing review completeness of
form and continuing review
progress report. form and progress
report.
2.1 Stamp
“RECEIVED”
2.2 Include in the
agenda of the
next meeting
3. Pay applicable 3..Receive payment P 10,000.00 20 minutes Cashier
fees and and issue official
photocopy official receipt
receipt
(Cashier-
Basement MAB)
4. Present official 4..Check official None 5 minutes IERB Staff
receipt and submit receipt, receive and
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
photocopy of official file photocopy 14 days
receipt (IERB office) 4.1 Instruct to wait for
schedule of the next
meeting and result
of deliberation
1. Wait for the result 5. Deliberate and None 1 day IERB Board Members
of the deliberation arrive at a decision. Board Secretary
(PI study site) 5.1 Record the
decision.
2. Receive decision 6..Prepare and send None 5 days IERB Staff
handed personally decision to PI
to PI study site by 2.1 File the
IERB staff and receiving copy
sign receiving
copy.

Total P 10,000.00 20 days

D. Early Study Termination
1. Submit Early study 1..Receive and verify None 30 minutes IERB Staff
termination form study termination
and letter form and letter
requesting to requesting to
terminate the terminate the study
study 1.1 Include in the 14 days Designated Reviewer
(study is agenda of the
terminated upon next meeting,
receipt of the review and
letter, no need to archive.
wait for next IERB
meeting)

Total None 14 days

 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
E. Final Study Report
1. Submit filled out 1..Receive and stamp None 30 minutes IERB Staff
final study report filled-out final study
form and one (1) report form and
copy of completed copy of completed
paper paper.
(make sure to get 1.1 Include in the
acknowledgement agenda of the
receipt. next meeting.
2. Present, deliberate None 14 days Designated Reviewer
and archive final IERB Board
study report.
Total
None 14 days
People’s Day Program
The People's Day Program offers free medical check-up to first 100 Adult patients every 3rd Wednesday of the month from 8:00am to 12:00pm
at DAPA Hall (Ground Floor, Medical Arts Building). It aims to develop and evaluate a feasible screening, preventive and promotive program
for Cardiovascular Disease (CVD) at the Philippine Heart Center.

Office/Division: PREVENTIVE CARDIOLOGY DIVISION (PCD)/ CARDIOMETABOLIC SECTION

Classification: SIMPLE
Type of Transaction: G2C
Who may avail: First 100 walk-in Adult Patients registered every 3rd Wednesday of the month
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
People’s Day Program – DAPA Hall
People’s Day Patient form
3rd Wednesday of every month
FEES TO
CLIENT STEPS AGENCY ACTION PROCESSING TIME PERSON RESPONSIBLE
BE PAID
1. Register name 1. Conduct initial interview None 5 minutes Science Research Specialist I or
and fill-out 1.1. Issue number and assist in filling- Psychologist II
patient form at out patient demographic data
Station 1, DAPA 1.2. Instruct patient to proceed to DAPA Hall, G/F MAB
Hall, G/F MAB Station 2 for screening tests
2. Submit to 2. Conduct Screening Tests: None 15 minutes Science Research Specialist II and
Screening Tests 2.1. BP/ Heart Rate Science Research Specialist I
at Station 2-5 2.2. FBS/ Cholesterol
2.3. BMI/ waist and hips DAPA Hall, G/F MAB
2.4. ECG
2.5. Request patient to attend
orientation and lay forum
 FEES TO
CLIENT STEPS AGENCY ACTION PROCESSING TIME PERSON RESPONSIBLE
BE PAID
3. Attend 3. Conduct Lay Forum None 30 minutes Science Research Specialist I and
orientation and 3.1 Patient Orientation 2nd Year Adult Cardiology Fellow and
lay forum 3.2 Lecture on CVD Nutritionist
Risks and Nutrition
3.3 Instruct patient to DAPA Hall, G/F MAB
proceed to Station 6
4. Proceed to 4. Perform medical None 15 minutes Adult Cardiology Fellows
Station 6 for examination
physical 4.1. Give medical advice and patient
examination education DAPA Hall, G/F MAB
4.2. Give prescription if needed
4.3. Accomplish patient form with final
diagnosis
4.4. Refer patient with CVD risks to
Hypertension & Lipid Clinic at
Preventive Cardiology Division,
8/F MAB, or
4.5. If CVD suspect, give appropriate
diagnostic test requests and refer
to OPD Screening/Social Service
4.6. Patients with other medical
problems, refer to other
government agencies.
4.7. Instruct patient to proceed to
Station 7 for further instructions
 FEES TO
CLIENT STEPS AGENCY ACTION PROCESSING TIME PERSON RESPONSIBLE
BE PAID
5. Receive 5. Record patient None 10 minutes Science Research Specialist II
discharge demographic data,
instructions at laboratory results and DAPA Hall, G/F MAB
Station 7 final diagnosis
5.1. Clarify doctor’s advice
5.2. Explain doctor’s prescription and
laboratory requests
5.3. Issue appointment slip for next
follow-up if referred to
Hypertension & Lipid Clinic or
5.4. Give instruction if referred to
OPD Clinic and Social Service
5.5. Issue Client Satisfaction Survey
6. Fill out Client 6. Provide Information Education and None 5 minutes Science Research Specialist I
Satisfaction Communication (IEC) materials on
Survey and/or CVD risks DAPA Hall, G/F MAB
appointment slip
and come back
on appointment
date
1 hour and 20
Total None
minutes

End of Transaction
PHC-Funded Protocol
All approved research protocol by the CTRD forwarded to IERB for ethics review approval/ethical clearance.

Office/Division: Institutional Ethics Review Board

Classification: Highly Technical
Type of G2G to G2C: Government to Government; Government to Citizens
Transaction:
Who may avail: Fellows, Nurses, Consultants and other Employees
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
A. Initial Review
1. Protocol package (1 original, 10
photocopies) - Principal Investigator/Clinical Trial and Research Division (CTRD) Staff
2. Informed Consent Form (ICF) English
and Filipino Version or Waiver of
Written Informed Consent Form (For
Adult).
3. Assent Form and Parent
Information/Informed Consent Form
English and Filipino version – Pediatric
Patient or Waiver of Written Informed
Consent Form
3.1 Verbal Assent (7-12 y/o)
3.2 Simplified Assent (12-15 y/o)
3.3 Co-sign with parents/Legally
Authorized Representative for ICF-
15-18 y/o)
4. Curriculum Vitae and Good Clinical
Practice Certificate of Primary and
Sub-Investigator
5. Budget Proposal
6. Research Protocol Approval Form
7. Filled out Initial application form and
 document receipt
B. Resubmission
1. One (1) copy of revised protocol - PI
package
C. Continuing Review Requirements
1. Filled out Continuing Review Form - PI
2. If with changes by the Principal
Investigator
- One (1) copy of revised protocol and
ICF
- Original copy of protocol with
highlights of changes
- Amendment application form
D. Early Study Termination
1. Filled out Study termination form - PI
2. Letter requesting to terminate
E. Final Study
1. Filled out final study report form - PI
2. One (1) copy of completed paper with
an abstract
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
A. Initial Review
1. Submit 1..Check requirements, None 14 days IERB Staff
requirements stamp "received"
(IERB Office and sign the
document receipt
8/F MAB)
form.
1.1 Sign CTRD
receiving copy
logbook.
1.2 Record and
encode protocol
and assign
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
IERB number.
1.3 Prepare receipt Designated reviewers
and assessment
form of protocol
package and
distribute to
designated
members for
review.
1.4 File the original
protocol
package.
1.5 Include in the
agenda of the
next IERB
meeting.
1.6 Instruct the
CTRD staff to
wait the PI for
date of
presentation.
2. Come back to 2. Evaluate the None 1 day Designated Reviewer
IERB office for protocol/documents
presentation of (Scientific and
protocol Informed consent
form) Primary/Designated
2.1 Summarize the Reviewer
findings
2.2 Record the Board Secretary
decision of
IERB and
instruct client to
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
wait for any
modifications
3. Prepare decision None 5 days IERB Staff
and send to PI
3.1 File the
receiving copy

Total None 20 days

B. Resubmission
1..Submit one (1) 1..Receive, check and None 14 days IERB Staff
copy of revised stamp “RECEIVED”
protocol package revised protocol
package.
1.1 Notify and
distribute
protocol package
to chair and
designated
reviewer.
1.2 Include in the
agenda of the
next meeting
2. Present and review None 1 day Designated reviewer
protocol in an en
banc meeting Board Secretary
2.1 Record decision

3. Prepare decision None 5 days IERB Staff

and send to PI
3.1 File the
receiving copy
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

Total None 20 days

C. Continuing Review Schedule (2 months before expiration of approval)
1..Wait for notice of 1. Check and track the None 1 day IERB Staff
schedule of dates of approved
continuing review protocols
1.1 Send reminder
letter to PI
1.2 Remind to
submit progress
report or final
study report two
months before
the due date
2. Submit filled-out 2..Check for None 1 hour IERB Staff
continuing review completeness of
form and continuing review
progress report. form and progress
report.
2.1 Stamp
“RECEIVED”
2.2 Include in the
agenda of the
next meeting
2.3 Instruct to wait
for schedule of
the next
meeting and
result of
deliberation
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Wait for the result 3. Deliberate and None 1 day IERB Board Members
of the deliberation arrive at a decision. Board Secretary
(PI study site) 3.1 Record the
decision.
4. Receive decision 4..Prepare and send None 5 days IERB Staff
handed decision to PI
personally to PI 4.1 File the
study site by receiving copy
IERB staff and
sign receiving
copy.

Total None 20 days

D. Early Study Termination
1. Submit Early 1..Receive and verify None 30 minutes IERB Staff
study termination study termination
form and letter form and letter
requesting to requesting to
terminate the terminate the study
study 1.1 Include in the
(study is agenda of the
terminated upon next meeting, 14 days
receipt of the review and
letter, no need to archive.
wait for next IERB
meeting)

Total None 14 days

 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
E. Final Study Report
1. Submit filled out 1..Receive and stamp None 30 minutes IERB Staff
final study report filled-out final study
form and one (1) report form and
copy of copy of completed
completed paper paper.
(make sure to get 1.1 Include in the
acknowledgemen agenda of the
t receipt. next meeting.
2. Present, deliberate None 14 days Designated Reviewer
and archive final IERB Board
study report.

Total None 14 days

Philippine Food and Drug Administration (PFDA)
Philippine Heart Center-Institutional Ethics Review Board is one of the regulatory reviewers of the Philippine Food and Drug
Administration. The PFDA shall evaluate the protocol submitted by the Pharmaceutical companies and assign regulatory
reviewer specific for the research protocol.

Office/Division: Institutional Ethics Review Board

Classification: Highly Technical
Type of Transaction: G2B: Government to Business
Who may avail: Pharmaceutical Companies
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Protocol package (8 copies) - Pharmaceutical Companies/Sponsor

2. CD-ROM/DVD-ROM (1 electronic copy)
3. Philippine Food and Drug Administration
Regulatory Review Permit
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit 1. Check None 5 days IERB Staff
requirements and requirements,
stamp "received"
email
and sign.
endorsement 1.1 Provide a copy
letter from FDA. of protocol
package to
1.1 Receive Sponsor.
statement of 1.2 Sign courier
account for delivery and
ethics review acknowledgment
fee.(Email:irbp receipt.
[email protected] 1.3 Record and
m) encode protocol
and assign IERB
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.2 Send number.
payment via 1.4 Prepare receipt 39 days
and assessment Primary Reviewer/
courier
(Triload) form of protocol
package and Independent Consultant
distribute to
primary reviewer
and independent
consultant for
review.
1.5 File the original
protocol
package
1.6 Include in the
agenda of the
next IERB
meeting.
1.7 Issue statement
of account.
1.8 Instruct to wait
for date of FDA
meeting.
2. Pay applicable 2..Receive payment P 60,000.00 20 minutes Cashier
fees and issue official
(Cashier- receipt
Basement,
hospital building
ground floor)
make sure to get
official receipt
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3. Present official 3..Photocopy official None 10 minutes IERB Staff
receipt to IERB receipt, stamp
(8/F MAB) received and file
3.1 Notify sponsor
that official
receipt is
available for pick
up.
3.2 Return original
copy (Triload-
Courier)
3.3 Instruct to wait
the result of FDA
meeting and
once approved
will forward the
assessment to
FDA.
4. Wait for the result 4. Evaluate the protocol None 1 day Primary Reviewer/
of meeting. package Independent Consultant
4.1 Summarize the
findings Board Secretary
4.2 Record the
decision of IERB.
5..Prepare decision and None 5 days IERB Staff
send to FDA
1.1. File assessment
form with
signature of
chairman.
Total P 60,000.00 45 days (TAT per FDA)
See FDA guidelines
Post-Graduate Internship Training Rotation
This is a rotation of Post-Graduate Interns matched to the Department of Health Integrated Internship Training Program of the Philippine
Center for Specialized Health Care (PCSHC).

Office/Division: Medical Training Division

Classification: Highly Technical
Type of Transaction: G2C: Government to Government
Who may avail: Post-Graduate Interns accepted by the DOH-PCSHC
CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Endorsement letter from Philippine Center for Specialized Philippine Center for Specialized Health Care (PCSHC) Office
Health Care (PCSHC) and schedule of rotation per batch.

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit an Accept the endorsement letter
endorsement letter and schedule of rotation,
and schedule of forward to the concerned None 1 working day Medical Training Staff
rotation of the Post- department and give information
Graduate Interns sheet
2. Post-Graduate Interns
fill up information None None 10 minutes None
sheet
3. Claim
Identification Issue Identification Card None 3 minutes Medical Training Staff
Card
4. Come on
Scheduled N/A None N/A N/A
rotation
Total None 15 days
End of Transaction
REQUEST FOR CERTIFICATE OF CONFINEMENT
(direct request at the Medical Records Window)
This document certifies that the patient is currently confined in our institution. The content includes the name of patient,
age, address, date of admission, name of requesting party, his/her relationship to patient and shall be signed by a Medical
Records Officer. Once the patient is discharged, the appropriate document to be requested from and issued by the Records
Officer is a Medical Certificate.

OFFICE OF THE DIVISION: MEDICAL RECORDS SECTION

CLASSIFICATION: Simple
TYPE OF TRANSACTION G2C – Government to Citizen
WHO MAY AVAIL: Authorized representative of presently confined patients
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
For Representative

Request for Health Information Form(FM-E-CRD-MLD- Medical Records Office–near Window 1

MRS- 2017-005)( 1 original form with current date of request)

Queue Card Medical Records Office –near Window 1

Letter of Authorization from Patient (1 original copy ) Person being represented

or Special Power of Attorney If married–spouse, children (18y/o and above
(1 original copy) ( 1 photocopy) If single – parent, sibling

Government Issued Identification Cards of patient and BIR, Post Office, DFA, PSA, SSS, GSIS, Pag-IBIG, OSCA, LTO,
representative PhilHealth, COMELEC, PRC, POEA
(1 original copy and one photocopy with specimen signature)

Subpoena (1 photocopy) -- if it will be used for Court From Patient/ Watcher issued by court /DOJ
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Sworn statement - in cases when there is a Law office
(one copy) need to support the
statement / claim of
patient’s representative
PLEASE TAKE NOTE:
If patient’s data has some DISCREPANCY or NEEDS SOME
SUPPORTING DOCUMENTS before processing the
request, please provide one (1) PHOTOCOPY and the
original copy of the document being requested for verification

Barangay Certificates - In case of change or Barangay or Municipal Hall

additional address

Birth Certificate of patient– in case of some Philippine Statistics Authority (PSA) / Local Civil Registrar
discrepancy on patient’s
name, date of birth, age,
father’s name,
mother’s maiden name

Birth Certificate of patient - as proof of PSA/ Local Civil Registrar

And/or Birth Certificate of relationship
patient’s representative

Death Certificate of spouse, as proof of death parents, sibling PSA / Local Civil Registrar
of next of kin, for guardianship of patient
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Marriage Certificate or -for patient’s status Philippine Statistics Authority (PSA)
CENOMAR (Certificate (single to married)
of No Marriage - for status
(married to single)

Passport or ACR ID / - as proof of citizenship if DFA or other similar agency in country of origin / Bureau of
Certificate of Citizenship patient is a foreigner Immigration

Social Case Study Report/ Adoption papers DSWD near your residence

Sworn statement- in cases when there is a need to Law Office

support the statement / claim of patient’s representative

CLIENT STEPS AGENCY ACTION FEES PROCESSING TIME PERSON RESPONSIBLE

TO BE PAID

1. Present the Request Form, 1. Interview the None 7 minutes Medical Records
necessary requirements patient/relative Officer II,
and Queue Card when to check the MRO I,
called to any Window of completeness and or Clerk IV
Release of Information (ROI) legality of the
counters accomplished
* Failure to properly accomplish request form and
the Request Form will cause requirements.
delay in the processing of
your request.
* Please take note of the
reminder regarding additional
requirements on special cases
(see above)
 CLIENT STEPS AGENCY ACTION FEES PROCESSING TIME PERSON RESPONSIBLE
TO BE PAID

2. Wait for processing of your 2. Process Certificate None 5 minutes Medical Records
documents of Confinement. Officer II, MRO I,
2.1 Have the or Clerk IV
Certificate signed
by Medical
Records Officer.

3. Receive the Certificate of 3. Document the None 3 minutes Medical Records

Confinement from any transaction and Officer
window of ROI counters release the Or Clerk IV
when called requested
certificate.
TOTAL None 15 minutes

END OF TRANSACTION
REQUEST FOR CERTIFICATE OF CONFINEMENT
(forwarded request from the Nursing Unit)
This document certifies that the patient is currently confined in our institution. The content includes the name of
patient, age, address, date of admission, name of requesting party, his/her relationship to patient and shall be signed by
a Medical Records Officer. Once the patient is discharged, the appropriate document to be requested from and issued
by the Records Officer is a Medical Certificate.

OFFICE OF THE DIVISION: MEDICAL RECORDS SECTION

CLASSIFICATION: Simple
TYPE OF TRANSACTION G2C – Government to Citizen
WHO MAY AVAIL: Authorized representative of presently confined patients

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

For Patient

to accomplish the Request for Health Information Nurses’ Station near patient’s room
Form(FM-E-CRD-MLD-MRS- 2017-006 )

For Representative,

to accomplish the Request for Health Information Nurses’ Station near patient’s room
Form(FM-E-CRD-MLD-MRS- 2017-006 )

Subpoena (1photocopy) -- if it will be used for Court Patient/ Watcher issued by court /DOJ

Letter of Authorization or -- if the patient cannot sign Person being represented

or Special Power of Attorney the next of kin is not If married–spouse, children
available. (18y/o and above
If single – parent, sibling
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE

Sworn statement -- in cases when there is Law Office

(one copy) a need to support the
statement / claim of
patient’s representative
Government Issued Identification Cards of patient BIR, Post Office, DFA, PSA, SSS, GSIS, Pag-IBIG, OSCA, LTO,
and representative PhilHealth, COMELEC, PRC, POEA
(1 original copy and one photocopy with specimen
signature)

For Ward Clerk

Patient Data Sheet Nurse’s station
Accomplished Request Form signed by patient or Patient/ Watcher
representative (1 copy)
Necessary Requirements for Representative Patient/ Watcher
(1 photocopy of each document and original copy to be
presented)
PLEASE TAKE NOTE:

If patient’s data has some DISCREPANCY or NEEDS

SOME SUPPORTING DOCUMENTS before
processing the request, please provide one (1)
PHOTOCOPY and the original copy of the document
being requested for verification
Affidavit of Loss -- In case of loss of Notary Public
document
Barangay Certificates -- In case of change or Barangay or Municipal Hall
additional address
 CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Birth Certificate of patient – in case of some Philippine Statistics Authority (PSA)
discrepancy on patient’s
name, date of birth,
age, father’s name,
mother’s maiden name
Birth Certificate of representative -- as proof of PSA/ Local Civil Registrar
relationship
Passport/Certificate of Citizenship – for citizenship of Embassy / DFA / Bureau of Immigration
patient / ACR
Marriage Certificate or -- for patient’s status Philippine Statistics Authority (PSA)
CENOMAR (Certificate of (single to married)
No Marriage - for status
(married to single)

Death Certificate of spouse, parents, siblings PSA / Local Civil Registrar

-as proof of death ( next of kin)
Social Case Study Report/ Adoption papers DSWD near your residence
Sworn Statement – in some cases, when Law Office
there is a need to support
the statement/claim of
patient’s representative
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE

1. Present the properly 1. Check the None 7 minutes Medical Records Officer II,
accomplished completeness MRO I,
Request Form, of accomplished or Clerk IV
necessary Request Form,
requirements and requirements and
Patient Data Sheet to its legality.
Records Officer
/Clerk.

2. Wait for Certificate to 2. Process the Certificate None 10 minutes Medical Records Officer II,
be processed of Confinement. MRO I,
2.1 Have the Certificate or Clerk IV
signed by
Records Officer II.
3. Receive the 3. Document the 7 minutes Medical Records Officer Or
Certificate transaction and release Clerk IV
of Confinement on to Ward Clerk .
behalf of the
requesting party .
Ward Clerk
3.1 Return to Nursing
Unit and release
the signed
Certificate to
patient
/ authorized
representative
or to Nurse on
Duty.
TOTAL None 24 minutes

END OF TRANSACTION
Request for Hospital Guided Tour
Guided tour is provided to nursing colleges/universities and other agencies who would like to see the facilities of the Philippine Heart
Center and get to know the services it offers.

Office/Division: Nursing Education and Training Division (NETD)

Classification: Simple
Type of Transaction: G2B Government to Business
Who may avail: Nursing Schools
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request for Guided Tour (1 original copy) Requesting agency (College / University)
* Scheduled on Tuesdays and Thursdays only at 1:00-3:00 pm
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit request for 1. Receive the request letter None 2 days Secretary-on-duty
guided tour at Education, 1.1. Check for completeness of ETRS Reception Area
Training and Research content.
(ETRS) Office, 2nd floor 1.2. Nursing Education and
Medical Arts Building Training Division (NETD) Secretary-on-duty
(MAB) facilitates the following: NETD Reception Area
- Plotting of tour
schedule
- Venue
- Person who will
conduct the tour
2. Report to NETD Office 2. Ask Clinical Instructor or None 2 hours Secretary-on-duty
nd
at 2 floor MAB school representative to sign NETD Reception Area
the Guided Tour logbook
*Limited to 40 persons per 2.1. Conduct Nursing Service Ward
session orientation/briefing Clerk
2.2. Guided hospital tour
Total None 2 days and 2 hours
End of Transaction
REVIEW OF CLINICAL TRIALS FROM OUTSIDE PHILIPPINE HEART CENTER
Process of clinical trials submitted and to be conducted at the Philippine Heart Center.

Office/Division: Clinical Trial and Research Division

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: Researcher coming from outside Philippine Heart Center such as Pharmaceutical or Private Companies
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1 copy of Research Proposal Researcher
1 copy of Letter of Intent signed by the Principal Researcher
Investigator and addressed to the following:
 MARIA TERESA B. ABOLA, M.D.
Department Manager III
Clinical Research Department
 ALEXANDER A. TUAZON, M.D.
Division Chief
Clinical Trial and Research Division

CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit letter of 1. Receive, check and log None 5 minutes CTRD Clerical Staff
intent and research submitted proposal CTRD Office 9th Floor
protocol Medical Arts Building (MAB)

1.1. Review and approve None 5 minutes CTRD Division Chief

the proposal CTRD Office
9th Floor MAB
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.2 Make a response Php 100, 000.00 5 minutes Science Research
letter addressed to Specialist I
the Researcher, CTRD Office
including conditions/ 9th Floor MAB
conforme letter and
Statement of Account
for the Technical
Review Committee /
Institutional Fee which
signed by the CTRD
Chief.
1.3 Once signed, will None 10 minutes Science Research
contact the Principal Specialist I
Investigator where to CTRD
send the letters to 9th Floor MAB
his/her preferred
office or clinic, pick up
or send via email.
2. Receive condition 2. Make a receiving copy or None 5 minutes Science Research
letter/conforme and have it received in CTRD Specialist I
Statement of outgoing logbook CTRD
th
Account. 9 Floor MAB

3. Settle payment of 3. Instruct the client for None 5 minutes Science Research
Technical Review payment at the Specialist I
Committee / Treasury Division CTRD
Institutional Fee 9th Floor MAB
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3.1. Wait for the signed None 22 days Science Research
conforme letter and 1 Specialist I
copy of the official CTRD
receipt for the
Technical Review 9th Floor Medical Arts
Committee / Building
Institutional Fee.

4 Submit conforme 4 Check and receive the None 5 minutes Science Research
letter and 1 copy of letter which signed by the Specialist I
receipt. Principal Investigator with CTRD
the date and 1 copy of proof
of payment for the Technical 9th Floor Medical Arts
Review Committee Fee Building

4.1 For Review and None 22 days Technical Review

approval of the Committee(TRC)
Technical Review 9th Floor Medical Arts
Committee Building

4.2 Once approved, None 10 minutes Science Research

Inform the Principal Specialist I
Investigator CTRD
regarding 9th Floor Medical Arts
Institutional Ethics Building
Review Committee
requirements
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
5 Submit complete 5. Check and receive None 60 minutes CTRD Admin Staff
IERB research research requirements and
requirements prepare according to IERB
protocol of submission.
5.1 Forward to IERB the None 10 minutes CTRD Clerical Staff
complete set of
research protocol

5.2 Wait for the None 44 days Science Research

approval Specialist
of the Institutional CTRD
Ethics Review
Board 9th Floor Medical Arts
Building
5.3 Once approved, None 1 day Science Research
make an Specialist I
implementation CTRD
letter and sign by
the Clinical 9th Floor Medical Arts
Research Building
Department
Manager
6 Receive an 6. Record and have it None 1 day CTRD Clerical Staff
implementation receive by the Principal 9th Floor Medical Arts
letter from CTRD Investigator Building

7 Submit an annual 7 Check and update None 5 minutes Science Research

report research database Specialist I
CTRD
th
9 Floor Medical Arts
Building
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
8 Submit a final 6.1 Check and update None 5 minutes Science Research
paper research database Specialist I
CTRD

9th Floor Medical Arts

Building
Total Php 100, 000.00 90 days and 60 minutes
End of Transaction
REVIEW OFNON-HOUSE STAFF RESEARCH PAPER OF PHILIPPINE HEART CENTER
Process of submitted research paper of Medical Staff, Nurses and other Allied Health Professionals to be conducted at the Philippine Heart
Center.

Office/Division: Clinical Trial and Research Division

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: Researcher coming from Schools or Private Companies
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1 copy of Research Proposal - Researcher

1 copy of Letter of Intent signed by the Principal - Researcher

Investigator and addressed to the following:

MARIA TERESA B. ABOLA, M.D.

Department Manager III
Clinical Research Department

ALEXANDER A. TUAZON, M.D.

Division Chief
Clinical Trial and Research Division
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit letter of 1. Receive, check and log None 5 minutes CTRD Clerical Staff
intent and research submitted proposal 9th Floor Medical Arts
protocol Building
1.1 Review and approve None 5 minutes CTRD Division Chief
the proposal 9th Floor Medical Arts
Building
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.2 Make a response None 5 minutes Science Research
letter addressed to Specialist I
the Researcher such CTRD
as condition /
conforme letter. 9th Floor Medical Arts
Building
1.3 Once signed, will None 10 minutes Science Research
contact the Principal Specialist I
Investigator where to CTRD
send the letters to 9th Floor Medical Arts
his/her preferred Building
office or clinic, pick up
or send via email.

2. Receive condition 2 Make a receiving copy or None 5 minutes CTRD Clerical Staff
letter/conforme have it received in CTRD 9th Floor Medical Arts
outgoing logbook Building
2.1 Wait for signed None 22 days Science Research
conforme letter Specialist I
CTRD

9th Floor Medical Arts

Building
3. Submit conforme 3 Check and receive the None 5 minutes Science Research
letter and 1 copy letter which signed by the Specialist I
of receipt. Principal Investigator with CTRD
the date.
9th Floor Medical Arts
Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
3.1 For Review and None 66 days CTRD Staff, Technical
approval of the Review Committee(TRC)
Technical Review 9th Floor Medical Arts
Committee Building
3.2 Once approved, None 10 minutes Science Research
Inform the Principal Specialist I
Investigator CTRD
regarding 9th Floor Medical Arts
Institutional Ethics Building
Review Committee
requirements and
provide Research
budget proposal
form
4 Submit 9 copies of 4. Check and receive None 60 minutes CTRD Admin Staff
approved research research requirements and
protocol by the prepare according to IERB
Technical Review protocol of submission.
Committee and
research budget
proposal form
4.1 Forward to IERB the None 10 minutes CTRD Clerical Staff
complete set of
research protocol

4.2 Wait for the None 44 days Science Research

approval Specialist
of the Institutional CTRD
Ethics Review
Board 9th Floor Medical Arts
Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
4.3 Once approved None 5 Minutes CTRD Clerical Staff
Submit Research
Budget Proposal to
Budget Division, if
no budget proceed
to Step 4.2

4.4 Wait for the None 1-2 days CTRD Admin Staff
approval from
Research Budget
Office

4.5 Once approved, None 5 minutes Science Research

make an Specialist I
implementation CTRD
letter and sign by
the Clinical 9th Floor Medical Arts
Research Building
Department
Manager

5 Receive an 5 Record and have it None 10 minutes CTRD Clerical Staff

implementation letter receive by the Principal 9th Floor Medical Arts
from CTRD Investigator Building

6 Submit an annual 6 Check and update None 10 minutes Science Research

report research database Specialist I
CTRD
9th Floor Medical Arts
Building
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
7 Submit a final paper 6.1 Check and update None 5 minutes Science Research
research database Specialist I
CTRD

9th Floor Medical Arts

Building
Total None 1-2 Years
End of Transaction
Education, Training and Research Services
Internal Services
AVAILMENT OF RESEARCH GRANT / FINANCIAL ASSISTANCE FOR RESEARCH PRESENTATION
Process for the application of research grants or financial assistance for research presentations.

Office/Division: Clinical Trial and Research Division (CTRD)

Classification: Complex
Type of Transaction: G2C
Who can avail: Medical Consultants with Plantilla position, Fellows and Residents, Nurses and Allied Health Professionals employed
in the Philippine Heart Center
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1 copy of Letter asking for research grant or official time signed - Research applicant
by the Researcher and Department Manager or Division Chief
1 copy of proof of acceptance letter from the Society or Event - Society or Event Organizer
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submission of letter of asking 1. Receive and log request None 5 minutes CTRD Clerical Staff
for research grant letter
1.1 Division Chief reviews None 5 minutes CTRD Division Chief
and considers for approval
the research grant request
letter
1.2 Upon approval, a letter None 10 minutes CTRD Admin Staff
of request with specific
amount of financial support
according to classification of
research presentation is
made and duly endorsed to
Clinical Research
Department
1.3 Review and approve the None 1 hour Clinical Research
financial support request Department Manager
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.4 Approve/Disapprove None 3 hours ETRS Deputy Executive
request. If approved, Director
forward to Executive
Director’s Office
1.5 Approved/Disapprove None 3 hours Executive Director
request
1.6 Inform requesting None 10 minutes CTRD Admin Staff
House Staff or nursing
personnel of
approval/disapproval. If
approved, forward
communications to the
Human Resource
Management Division
(HRD) for processing of
official time/business.
1.7 Waiting for None 3 days HRMO I
Memorandum from the Human Resource
HRMD Management Division
1.8 Once memo is received None 10 minutes CTRD Admin Staff
by CTRD, a voucher is
made for signature by
CTRD Division Chief
1.9 Forward signed voucher None 10 minutes CTRD Clerical Staff
with supporting documents
to Accounting Division for
auditing
2. Wait for the release of check 2. Cheque preparation and None 3 days Clerk IV
signing by appropriate Cashier’s Office
authorities
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2.1 Once available, contact None 5 minutes Audio Visual Tech II
the applicant. CTRD
3. Fellow Claim of Research 3. Issuance of Cheque from None 5 minutes Cashier III
Grant the Credit and Collection Cashier’s Office
Division
None 6 days and 8 hours
Total
or 7 days
End of Transaction
In-Service Lay Rescuer Cardiopulmonary Resuscitation (CPR), Basic Life Support, Advanced Cardiac Life
Support, and Pediatric Advanced Life Support Training Courses
Process for Philippine Heart Center (PHC) employees for registering, attending training, and for receiving a certificate in In-Service
Cardiopulmonary Resuscitation (CPR), Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Cardiac Life
Support (PALS) training courses.

Office/Division: Medical Education Division

Classification: Simple
Type of Transaction: G2G (PHC Staff)
Who may avail: • Physicians employed by or undergoing fellowship/residency training in the PHC.
• Nurses and other healthcare providers employed by the PHC.
• Visiting consultants.
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. 1 copy of 2x2 ID picture 1. Client
2. Photocopy of PHC ID 2. Client
3. Appropriate Basic Life Support Certificate/ID (For ACLS and 3. Client
PALS training applications)
4. Routing Slip 4. Unit of assignment
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Proceed to Medical Education 1. Check availability of slot. None 10 minutes Training Specialist II
Division (MED) office. 1.1. Give client a slot Audio Visual Tech II
1.1. Ask for an available slot Training Specialist III
for the following MED Office
th
training/s: 5 Floor Medical Arts
− Lay Rescuer CPR Building (MAB)
− BLS,
− ACLS, and/or
− PALS.
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1.2. Make a routing slip for the 1.2. Check available None 60 minutes Ward Clerks
following nurses who will requirements Nursing Units
attend the scheduled 1.3. Register the Nursing Training Specialist II
trainings and submit to Staff, listed in the Audio Visual Tech II
NETD. approved official list Training Specialist III
from Nursing Education MED Office
th
and Training Division 5 Floor Medical Arts
(NETD). Building (MAB)
2. Fill-out sign the following 2. Assist client in filling out of None 30 minutes Training Specialist II
forms: forms. Audio Visual Tech II
2.1. Registration form 2.1. Check information written Training Specialist III
2.2. Training Terms and in all forms are correct. MED Office
Conditions 2.2 Make sure that the client 5th Floor Medical Arts
2.3. Pre-course Letter (BLS/ signs all the conforme and Building (MAB)
ACLS /PALS) agreement forms.
2.4. AHA e-books access forms.
(BLS/ACLS/PALS)
3. Receive order of payment for 3. Issue order of payment slip. 2 minutes Training Specialist II
the fees to be paid. 3.1. Give instructions regarding 2 minutes Audio Visual Tech II
payment procedure. Training Specialist III
3.2. Direct participant to 2 minutes MED Office
th
proceed to the cashier’s office 5 Floor Medical Arts
located at the basement or 4th Building (MAB)
floor of the MAB.
4. Proceed and pay applicable 4. Receive payment and issue Course fee: 30 minutes Cashier
fees at the cashier’s office official receipt (OR). BLS: P230.00 Cashier’s Office
(basement or 4th flr, MAB Bldg.) ACLS: P270.00 4th Floor MAB or
PALS: P270.00 Basement MAB

E-book fee
BLS: P770.00
ACLS: P2,070.00
PALS: P2,440.00
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
5. Proceed back to Medical 5. Get the OR from the client. None 10 minutes Training Specialist II
Education Division and present 5.1. Enlist the name of client in Audio Visual Tech II
the official receipt and receive the registration list. Training Specialist III
instructions 5.2. Give instruction on how to MED Office
th
access the e-book. 5 Floor Medical Arts
5.3. Inform client of the Building (MAB)
date/time and venue of the
course.
6. Attend scheduled training. 6. Assist in registration: None Schedule of Instructors
6.1. Proceed to the venue (Heart 6.1. Ask client to register in the trainings:
3) before 8:00 AM laptop provided. BLS – 4 hrs
6.2. Register your attendance in ACLS – 1 ½ days
the electronic data base (please PALS – 2 days
make sure to correctly type your
name and other information 10 minutes
required)
7. Take the examination 7. Give client examinations None 1 hour (Part of Instructors
training hours.
8. Wait for certificate 8. Process certificate None 5 hrs. 24 mins. Audio Visual Tech III
MED Office
5th Floor Medical Arts
Building (MAB)
Total Course fee (CF): 24 hours (3 working days) – PALS
BLS: P230.00 20 hours (2 working days and 4hrs) – ACLS
ACLS: P270.00 12 hours (1 day and 4hrs) – BLS
PALS: P270.00
CF with E-book:
BLS: P1,000.00
ACLS: P2,340.00
PALS: P2,710.00
End of Transaction
REQUEST FOR PATIENT’S MEDICAL RECORD FOR PATIENT CARE AND CLINIC USE
Previous medical records (whole records) of patients are sometimes borrowed by their attending physicians for patient care or
clinic use in case of re-admission or follow-up consultation.

OFFICE OF THE DIVISION: MEDICAL RECORDS SECTION

CLASSIFICATION: Simple
TYPE OF TRANSACTION G2G – Government to Government,
G2C – Government to Citizen
WHO MAY AVAIL: Attending doctors / authorized representative of attending doctor

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

For Representative of attending doctors
Accomplished Doctor’s Request Form signed by Attending physician from clinic
attending doctor or attending fellow at the ER / Ward

ID issued by Philippine Heart Center Philippine Heart Center

CLIENT STEPS AGENCY ACTION FEES PROCESSING TIME PERSON RESPONSIBLE

TO BE PAID

1. Inform the Med Records 1. Verify the ff. info: None 5 minutes Doctor’s Secretary,
to prepare the patient's patient's name, hospital Clerk III
chart and advise the no. , discharge date,
secretary to call after status of chart in
10mins. Medtrak.
 2. Have the requesting 2 . Locate and retrieve None 20 minutes Doctor’s Secretary,
doctor accomplished the Clerk III
and sign the Doctor's chart using Tracer
Request Form. Slip
2.1 Verify if requested /Discharge List.
chart is available

3. Received the requested 3. Have the doctor's None 5 minutes Doctor’s Secretary,
chart. representative sign the Clerk III
3.1 Write the date, name of Borrower’s card.
doctor, name of 3.1 Document in the
secretary and affix your Chart Circulation
signature on the Logbook
Borrower’s card. 3.2 File the doctor’s
request form and
borrower's card
properly.
TOTAL None 30 minutes

END OF TRANSACTION
REQUEST FOR JOURNAL ARTICLES
This service is a request for journal or related articles that will be used by researchers for their researches.

OFFICE OR MEDICAL LIBRARY SECTION

DIVISION:
CLASSIFICATION: Simple
TYPE OF G2G – Government to Government
TRANSACTION:
WHO MAY AVAIL: PHC Heads, Consultants & Staff – Nursing, Medical, Administrative and Education Training & Research
Services
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1. Complete bibliographic data of requested literature or Pubmed, Google Scholar
Digital Object Identifier
2. Email address of requesting party/client
CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON RESPONSIBLE
TO BE TIME
PAID
1. Email/submit 1. Acknowledge receipt of request none Day 1 Medical Library Staff
request for literature 10 minutes
request/s via SMS,
electronic mail, phone
call or in person.
2. Receive the 2. Send literature request/s (if none Day 2-3 Medical Library Staff
requested literature/s available) thru email or printout 16 hours
or feedback regarding
the requested
literature

TOTAL none 3 days

END OF TRANSACTION
REQUEST FOR PATIENT’S RECORD FOR RESEARCH, CONFERENCE AND GATHERING OF DATA

This pertains to Resident fellows request in order to comply with the research requirements and other activities to
complete their fellowship training.

OFFICE OR MEDICAL RECORDS SECTION

DIVISION:
CLASSIFICATION: Simple
TYPE OF
TRANSACTION: G2G – Government to Government
Doctors who were authorized by their training officers and Nurses by the Chief of Nursing Education
WHO MAY AVAIL: and Research Division
WHERE TO SECURE
CHECKLIST OF REQUIREMENTS
Approved Request for Patient’s Charts Form Medical Records Section 6th floor MAB Bldg
(FM-E-CRD-MLD-MRS-2017-007)
Name & Contact number of the borrowing doctor
 CLIENT STEPS AGENCY ACTION FEES TO BE PROCESSING TIME PERSON
PAID RESPONSIBLE

1.Submit the Approved 1. Receive the Request and None DAY 1 Clerk IV
Request Form for record the contact number 10 minutes
Patient’s chart and of requesting doctor/
attached the Listing if nurse. Chief
Medical Records Officer III
requesting for more 1.1 Have the request
than 5 charts. approved by the
*The name of patients Chief of the Medical
should have Library Division
corresponding hospital or Supervisor of the
numbers and Records Section.
discharge date.

2. Follow-up your 2 . Locate and retrieve the None DAY Clerk IV

request on Day 4. chart using Tracer Slip
/Discharge List. 2 TO 4
2.1 Verify the ff. info: patient's
name, hospital no. , 15minutes for each
discharge date, status of patient chart
chart in Medtrak if charts
are cannot be found in the
File.

3. Review the charts. 3. Inform the doctor/nurse None DAY 4 Clerk IV

once the charts are ready for
review. 5 minutes

TOTAL None 4 DAYS

END OF TRANSACTION
REQUEST FOR RESEARCH OF INPATIENT STATISTICAL DATA AND VARIOUS CASES / DIAGNOSES
This service is a request for acquiring and gathering of statistical data / information and listings of inpatients with various cases and
or diagnoses which can avail by the PHC Staff, Doctors with Plantilla and Consultants who are on-going training of their Specialty
and use as registry research. The statistical data and various cases / diagnoses form part of their research requirement and for
conference / presentation in and out of the country. The release of every data is with consideration to the Data Privacy Act (DPA)
known as Republic Act No. 10173.
OFFICE OR DIVISION: MEDICAL RECORDS SECTION

CLASSIFICATION: Complex
TYPE OF G2G – Government to Government
TRANSACTION:
WHO MAY AVAIL: PHC Consultants; PHC Staff (Doctors with Plantilla) - Administrative, Nursing, Medical and Education Training &
Research Services

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. PHC ID Personal
2. *Letter of Endorsement from the School (Masteral & PhD, School of the one requesting information
etc.) - (For personal use)
3. Request for Patient Chart Form (FM-E-CRD-MLD- Medical Records Section, 6/f MAB
MRS-2017-007)
 CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON RESPONSIBLE
TO BE TIME
PAID
1. Present PHC ID and 1. Receive and check filled out none Day 1 Librarian III
properly filled out request request form and Letter of 10 minutes
form: Endorsement;
1.1 Specify kinds of
request data (Statistics /List 1.1 Review requested data for
of Patients with Different its availability and feasibility.
Diagnoses and its inclusive
years) 1.2 Interview and explain the
1.2 Indicate ICD 10 Code complexity of request
for patients' case/ final
diagnosis (if known) 1.3 Instruct client to go to their
1.3 Provide approved Training Officer for endorsement
protocol / research No. of request and have it sign;
1.4 Submit Letter of
Endorsement from school (if 1.4 Advise to come back to the
for personal use) Medical Records Section for
approval of Chief Administrative
Officer or Medical Records
Officer III
2. Have the accomplished 2. Review and sign on the none Day 1 Training Officer of their
request form /Letter of request form / Letter of 15 minutes respective Specialty /
Endorsement signed by Endorsement. Services
Training Officer

3. Submit the 3. Review and mark notation none Day 2 Chief Administrative Officer /
accomplished request form on the request form if any 15 minutes Medical Records Officer III
signed already by Training 3.1. Approve and sign;
Officer for approval by 3.2 Advise client to return
Chief Administrative request form/ Letter of
Officer/MRO III at Medical Endorsement to in charge of
Records Section (MRS) Statistics – Librarian III
Office
 CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON RESPONSIBLE
TO BE TIME
PAID
4. Submit the request form 4. Receive, review and mark none Day 3 Librarian III
with complete signatories notation on the request form. 30 minutes
to Librarian III at MRS 4.1 Advise client to follow up
Office. after 3 to 5 days depends on
the complexity of the request.
4.2 Record the transaction in
the log book.
5. Wait and follow up for 5. Start processing the none Day 4 – 6 Librarian III
the request to be request: 24 hours
processed 5.1 Check if data on files
exists / Other diagnoses exist
already and requests are
repeatedly done –
update data for simple
information;
5.2 Extract needed data
through Medtrak Dbase
System;
5.2.1 Different diagnoses
and surgeries
5.2.2. Listings of patients
which form part of their study
5.2.3 Census of different
cases and itemized as pedia &
adult patients
5.3 Export raw data and
convert into excel ; sort out,
pivot and arrange in a particular
order;
5.4. Check and analyze that
all needed data are complete
and accurate and print data.
 CLIENT STEPS AGENCY ACTION FEES PROCESSING PERSON RESPONSIBLE
TO BE TIME
PAID

6. Receive the requested 6. Record the transaction in the none Day 7 Librarian III
data and sign in the logbook then release the same 5 minutes
logbook at MRS Office to client.

TOTAL none 7 days

END OF TRANSACTION
REQUEST FOR STATISTICAL DATA REPORT ON HOSPITAL DISCHARGES - (INTEROFFICE REQUEST)
This service is a request for acquiring and gathering of statistical data / information and census on various cases or diagnoses of
discharged patients being requested by the policy making bodies through interoffice request which forms part of the hospital reports
submitted to the different government agencies for hospital licensure and accreditation but with consideration to Data Privacy
Act (DPA) known as Republic Act No. 10173.
OFFICE OR MEDICAL RECORDS SECTION
DIVISION:
CLASSIFICATION: Complex
TYPE OF G2G – Government to Government
TRANSACTION:
WHO MAY AVAIL: PHC Consultants; PHC Staff (Doctors with Plantilla) - Administrative, Nursing, Medical and Education Training & Research
Services

CHECKLIST OF REQUIREMENTS WHERE TO SECURE

1. Routing Slip ( RS) Division / Unit, Office of the one requesting
Request from Government Agency
2. Memorandum from Government Agencies and other
Accredited Institutions of Government entities, (if any)
CLIENT STEPS AGENCY ACTION FEES PROCESSING TIME PERSON
TO BE RESPONSIBLE
PAID
1. Prepare and submit 1. Receive, review and mark none Day 1 Chief Administrative
Routing Slip / attach notation on RS / Memo 10 minutes Officer / Medical Records
Memorandum, if 1.1 Advise Clerk to have the RS / Officer III / Clerk
needed Memo receive by In-charge of
Statistics
 CLIENT STEPS AGENCY ACTION FEES PROCESSING TIME PERSON
TO BE RESPONSIBLE
PAID

2. Wait for any call 2. Receive, review and mark none Day 1 Librarian III – Incharge of
or questions notation on the RS 25 minutes Statistics
2.1 Check the availability and
feasibility of data
2.2 Call and inform concerned
PHC Staff about the request, then
advise to follow up after 3 to 5 days
depends on its complexity
2.3 Record the transaction in the
log book.

3. Wait and follow up 3. Start processing the request: none Day 2 – 6 Librarian III
for the request to be 3.1 Check if data on files exists / 40 hours
processed Other diagnoses exist already and
requests are repeatedly done –
update data for simple information;
3.2 Extract needed data through
Medtrak Dbase System;
3.2.1 Different diagnoses and
surgeries
3.2.2. Listings of patients which
form part of their study
3.2.3 Census of different cases
and itemized as pedia & adult
patients
3.3 Export raw data and convert
into excel ; sort out, pivot and
arrange in a particular order;
3.4. Check and analyze that all
needed data are complete and
accurate and print data.
 CLIENT STEPS AGENCY ACTION FEES PROCESSING TIME PERSON
TO BE RESPONSIBLE
PAID

4. Receive the 4. Record the transaction in the logbook none Day 7 Librarian III / Clerk
requested data then then release the same to PHC staff. (10 minutes)
sign in the logbook at
Medical Records
Section Office

TOTAL none 7 days

END OF TRANSACTION
Request for Training Certificates
This is the process of issuing certificate/s of training to nursing personnel of the Philippine Heart Center.

Office/Division: Nursing Education and Training Division (NETD)

Classification: Simple
Type of Transaction: G2C
Who may avail: Nursing Personnel
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
Request for Certificate Form (1 original copy) Downloadable from PHC Intranet

Authorization letter (1 original copy) Person requesting for Certificate/s of Training

*If requesting party is not personally available to claim
requested certificate/s
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submit request form 1. Receive the request form None 2 days Secretary-on-duty
at the Nursing Education NETD Reception Area
and Training Division 1.1. Check for completeness of
(NETD) Office, 2nd floor content.
Medical Arts Building 1.2. Check records of trainings
(MAB) attended by requesting personnel
1.3. Prepare certificate/s
requested to be signed by the
following:
- Program Coordinator
- NETD Division Chief
- Training and Education (TED)
Department Manager
- Education, Training and
Research (ETRS) Deputy
Executive Director (DED)
 CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
2. Claim certificate/s 2. Issue certificate/s None 5 minutes Secretary-on-duty
requested from NETD NETD Office
Office at 2nd floor MAB 2.1. Give copy of certificate/s to
requesting person or authorized
representative

2.2. Ask claimant to sign

receiving copy and logbook
Total None 2 days, 5 minutes
End of Transaction
REVIEW OF RESEARCH PROPOSALS FOR SUBSPECIALTY FELLOWSHIP, FELLOWSHIP AND RESIDENCY TRAINING PROGRAM
Research process for In-House research trainees.

Office/Division: Clinical Trial and Research Division

Classification: Highly Technical
Type of Transaction: G2C
Who may avail: Subspecialty Fellowship, Fellowship And Residency Trainee
CHECKLIST OF REQUIREMENTS WHERE TO SECURE
1 copy of Initial Research Proposal Form with signature of the Subspecialty Fellowship, Fellowship And Residency Trainee
Principal Investigator, Consultant Adviser, Training Officer and
Division or Department Manager
CLIENT STEPS AGENCY ACTION FEES TO BE PAID PROCESSING TIME PERSON RESPONSIBLE
1. Submission by Trainee of 1. Receive and log the None 5 minutes CTRD Clerical Staff
Topic to Technical Review research proposal and
Committee(TRC) forward to concerned Staff
1.1 Check and forward to None 15 minutes CTRD Admin Staff
concerned Technical
Review Commitee
1.2 Review and Approval of None If Approved = 5 days Technical Review Committee
his/her research topic of the
concerned Technical If Disapproved
Review Committee For Resubmission
= 10 days
1.3 Once approved, make a None 5 minutes Administrative Assistant I
letter addressed to the
researcher regarding
schedule of his/her research
protocol presentation
Presentation of Research 1.4 Present protocol to the None 30 minutes Technical Review Committee
Protocol to Technical Review Technical Review Committee
Committee
 1.6 Return the revised or None 1 day CTRD Admin Staff
commented paper to the
researcher via email For Researcher:
If Approved= 14 days

If Disapproved
For Resubmission of
new research
proposal or topic
= 7 days
2. Return of revised paper 2. Receive, check and None 30 minutes CTRD Admin Staff
forward to concerned
Technical Review Committee
3. Modification and Approval 3. Review and approval of None 44 days Technical Review Committee
of Protocol with Budget Form the Technical Review
Committee
3.1 Once approved, inform None 15 minutes CTRD Admin Staff and
the researcher for the Clerical Staff
Institutional Ethics Review
Board research requirements
by sending it to their office
4. Submit complete research 4. Check and receive None 60 minutes CTRD Admin Staff
requirements research requirements and
prepare according to IERB
protocol of submission.
4.1 Forward to IERB the None 10 minutes CTRD Clerical Staff
complete set of research
protocol
4.2 Wait for IERB approval None 44 days CTRD Admin Staff
5. Principal Investigator and 5. Make an implementation None Without Budget= 14 CTRD Admin Staff
concerned letter signed by the Clinical days
Department/Division Research Department
receives communication Manager With Budget
from CTRD for (Internal)=
implementation 22 Days

With Budget
(External)=
44 days
6. Data Collection 6. Monitor by the CTRD None 14 months from the CTRD Staff, Consultant
Admin Staff oral presentation of Adviser, Training Officer and
protocol Trainee
7. Submit Preliminary Result 7. For presentation to the None 30 minutes Technical Review Committee
for Technical Review Technical Review Committee
Committee Presentation
8. Presentation of Completed 8. For presentation to the None 26 months from Oral Technical Review Committee
Data Collection Technical Review Committee Presentation of
Protocol
9. Submission of Final Write - 9. To make sure the None 3 months prior to Technical Review Committee
up completeness of the graduation of the
research output trainee from their
respective training
programs
Total None 3 years
End of Transaction
 FEEDBACK AND COMPLAINTS MECHANISMS

How to send feedback? Answer the Feedback/Complaint Form and drop it at the designated suggestion and
complaint box at the Information Counter, located at Ground Floor, Hospital Lobby and all
other frontline services.

Contact Information/Public Assistance and Complaint Desk: 8-9252401 local 2140-2141/2150

or [email protected]
How feedback is processed? Everyday, the Administrative Officer IV of Patient Services Division opens all the suggestion
and complaint boxes and compiles and records all feedback submitted.

Feedback requiring answers are forwarded to the relevant offices and they are required to
answer within (3) days of the receipt of the feedback.

The answer of the concerned unit is then relayed to the citizen.

For inquiries and follow-ups, clients may contact the following numbers: 8-925-2401 local
2140-2141/2150.
How to file complaints? Answer the Feedback/Complaint Form and drop it at the designated suggestion and
complaint box at the Information Counter, located at Ground Floor, Hospital Lobby and all
other frontline services.

Complaints can also be filed via telephone. Make sure to provide the following information:
•Name Of Person Being Complained
•Incident
•Evidence
For inquiries and follow-ups, clients may contact the following numbers: 8-925-2401 local
2140-2141/2150 or [email protected]
How complaints are processed? The Administrative Officer IV of the Patient Services Division opens the suggestion and
complaint box on a daily basis and evaluates each complaint.

Upon evaluation, the Administrative Officer IV will forward the complaint to the relevant office
for their investigation and appropriate action.

The Administrative Officer IV shall create a report after the investigation. If the complaint is
resolved, the Administrative Officer IV will close the case. If the complaint needs further
management the Administrative Officer IV will coordinate to the Quality Assurance Office.

The Administrative Officer IV will give continuous update and feedback to the client.

For inquiries and follow-ups, clients may contact the following numbers: 8-925-2401 local
2140-2141/2150.
Contact Information of ARTA, PCC, CCB ARTA :[email protected]
PCC :8888
CCB :0908-881-6565(SMS)
 PHILIPPINE HEART CENTER OFFICIALS

JOEL M. ABANILLA, M.D. - EXECUTIVE DIRECTOR

DIRECTOR’S OFFICE
(8)925-24-01 LOCAL 3200, 3201

GERARDO S. MANZO, M.D. - DEPUTY EXECUTIVE DIRECTOR

MEDICAL SERVICES
(8)925-24-01 LOCAL 3202, 3240

JOSEPHINE M. GUILLERMO-LOPEZ, CPA, MBA - DEPUTY EXECUTIVE DIRECTOR

HOSPITAL SUPPORT SERVICES
(8)925-24-01 LOCAL 3221,3222,3223

MARIETTA A. VELASCO, RN MAN - ACTING DEPUTY EXECUTIVE

DIRECTOR, NURSING SERVICES
(8)925-24-01 LOCAL 3211, 3212, 3213

MARIA BELEN O. CARISMA, M.D. - DEPUTY EXECUTIVE DIRECTOR

EDUCATION, TRAINING AND RESEARCH SERVICES
(8)925-24-01 LOCAL 2117