1. OPD CLIENT ADMITTANCE. Midwife on Duty will ask you about your
reason for consultation; and will write clients data on the dispensary book
Free- OPD form
- Consent form
2. ASSESSMENT OF PATIENT. Midwife on Duty takes medical history of patients; get vital signs and records these in the Individual Treatment Record
Form (ITR). You will, then, be referred to the physician on duty.
FreeVital signs recorded
3. EXAMINATION OF PATIENT. Physical on Duty:

----- a. Examines patient.
----- b. Prescribes appropriates medicine and gives medical advice.
----- c. Refers patient to assigned personnel for issuance of medicine.
----- d. If hospitalization is requires, fill-up referral form to the hospital of choice.
Free- Laboratory result processed
- Medicines provided or prescribed
HIV Screening TestFree- Birth certificates and guardian consent for age 16 belo
- HIV counseling form
Other STD/STI Tests
1. INQUIRY. Inquire about laboratory services given and the requirements.N/AVital signs
2. PAYMENT OF FEES. Proceed to the City Treasurer’s Office and pay the required fees₱ 75.00
₱ 30.00
- Gram stain screened
- Urinalysis
3. PRESENT OFFICIAL RECEIPT. Present Official Receipt for Examination fee.N/AOfficial receipt preserved
4. REGISTRATION. Nurse Laboratory Aide:

----- a. Registers and interviews client
----- b. Records complaint and previous examinations.
----- c. Gives instructions on examination procedures.
----- d. Collects vaginal/endocervical urethral specimen.
₱75 for the gram stain examination
EEW’s must have the ff:
- Birth certificate
- Hepa B screening
- Urinalysis
- Police clearance
- Cedula
- Brgy. Clearance
- Mayor’s clearance
- 2x2 and 1x1picture
5. EXAMINATION. Medical Technologist:

----- a. Advises client about the time of release of results.
----- b. Examines specimen and releases result.
N/ALaboratory result provided
6. COUNSELING. Clients found positive for sexually Transmissible infections are given counselling.N/AResults of the gram stain examination and prescription and
medicines given by the physician
7. RELEASE OF HEALTH CARD. Medical Officer or City Health Officer.

----- a. Signs Health Card of clients with negative results and release card,
----- b. Gives medicine, advises clients with positive results and holds card.
N/AHealth card
1. REGISTRATION. Midwife on Duty gets data about the child or pregnant mother to be immunized. She looks at past immunization recordsFreeECCD or immunization record book
2. IMMUNIZATION. Midwife on Duty gives immunization, as requested.
FreeECCD or immunization record book
POSTIMMUNIZATION INSTRUCTIONS. Midwife gives mother or pregnant mother to postimmunization instructions and informs her about the schedule for the next round of immunization.FreeECCD or immunization record book
1. REGISTRATION. Midwife accomplishes the Home Based Maternity Record (HBMR) card of the mother.
Free- OPD Form
- Consent form
- Homebase monitoring record Card

----- a. Checks clients abdominal palpitation and informs the mother of her findings.
----- b. Gives mother health instructions on proper nutrition and maternity care.
----- c. Emphasizes the importance of reporting to CHO once she feels the occurrence of pregnancy danger signs.
----- d. Gives mother maternity care service.
Free- Admission forms
- Mother and Child book
- Laboratory request form
1. INQUIRY. Inquire how to avail free HPN/DM Medication
2. Medical consultation and prescription of medicines
3. Enrolment of patient
4. Counselling and lifestyle interventions
N/A- Vital signs
- Lab result Prescription
- Vital signs
- Lab results
- Prescription HPN/DM card
1. INQUIRE. Inquire about skin disease and the requirements for availing of free leprosy drugs. The midwife on duty will direct you to the nurse coordinator.N/A
2. ASSESSMENT/DIAGNOSIS. Nurse assesses patient for signs and symptoms of leprosy.- Referral letter from dermatologist
- SSS (Skin Slit Smear)
3. ENROLLMENT OF PATIENT. Nurse enrols patients for multi drug therapy and provides counselling.N/A
1. INQUIRY. Inquire about the TB Drug dispensary and the requirements for availing of free TB drugsN/AHistory taking done
2. INSTRUCTION FOR SPUTUM COLLECTION. Clients receive instructions for proper sputum collection.N/ADSSM result provided
3. COLLECTION AND SUBMISSION OF SPECIMEN. Midwife collects sputum specimen and submit it to the Medical Technologist for examination.N/ASputum specimen
4. ENROLLMENT OF PATIENT. TB Coordinator or Midwife on Duty:

----- a. Assesses the patient, if eligible as National Tuberculosis Program (NTP) Beneficiary.
----- b. If eligible, enrols patient and issues NTP identification card.
----- c. Gives patient info-education about TB Diseases and Control and the importance of the Directly Observed Treatment for Short Course Chemotherapy with his/her treatment partner.
----- d. Issues initial TB drug supply to treatment partner.
----- e. Instructs patient where to report for his daily intake of TB drugs; and about the follow-up sputum re-examination schedule.
N/A- For RC patients NTP card
- For CD patients CXR, TBDC NTP card
- NTP Card
A. Day care pupils (age 2-4)

----- Oral examination and counselling
----- Oral prophylaxis
----- Dental sealant application
----- Fluoride varnish application

B. Pregnant mothers

----- Oral examination and counselling
----- Oral prophylaxis (by referral)
----- Dental restoration (by referral)

C. School children

----- Oral examination and counselling
----- Oral prophylaxis (by referral)
----- Dental sealant
----- Fluoride varnish
----- Dental restoration (by referral)

D. Senior citizen’s 60 y/0 and above
₱30 per patient- Parent/s or Guardian’s written consent to treat
- Mother’s book
- Leaflets
- Parents/guardians written
consent to minors
1. REGISTRATION. Register name in a logbook. Midwife on duty takes and records patient’s blood pressure.Free- Patient’s information
- Vital signs recorded
----- a. Performs Tooth examination.
----- b. Performs tooth extraction ( if needed ).
----- c. Gives post extraction instructions about oral health.
----- d. Prescribes medicines.
₱30 per tooth- Prescription pad for patients (printed)
- Printed parents/guardian’s consent for minor patients
Laboratory services:

----- Urinalysis
----- Fecalysis
----- CBC
----- CBC w/ platelet
----- Gram stain
----- AFS
----- FBS
----- Blood typing
----- HIV Screening Test
Urinalysis – ₱50
Fecalysis – ₱50
CBC – ₱120
CBC w/ platelet –
Platelet - ₱75
Grams stain – ₱75
AFS – free
FBS (supply by DOH – for free)
Blood typing – free
(supply by
HIV testing - Free
- Lab. Request from physician
- Printed lab. Request with two signature
1. Med. Tech or Lab. Tech countersignedby the Head Med. Tech.
2. Pathologist

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