10/2/2018 ClinicSys ver. 3.

PHILIPPINE HEALTH INSURANCE CORPORATION

QUARTERLY REPORT FORM

NAME OF PCB PROVIDER

HEALTH FACILITY DATA
SUMMARY OF BENEFITS AVAILMENT (Members and Dependents)

I. Covered Period IV. Obligated Services

From July 2018
TARGET ACCOMPLISHMENT
To September 2018 OBLIGATED SERVICES
(for the quarter) (number)
Primary Preventive Services
II. PCB Participation No. 1. BP Measurement 0 861
Hypertensive 0 106

III. Municipality/City/Province
Nonhypertensive 0 767
2. Periodic Clinical Breast Examination 0 227
3. Visual Inspection with Acetic Acid 0 0

No. of Members/Dependents VII. Medicines Given No. of Members

VI. BENEFITS/SERVICES PROVIDED
V. Members and Dependents Served Given Referred (Generic Name) Dependents
Male Female TOTAL Primary Preventive Services M D M D I. Asthma M D
1. Consultation 782 2372 VITAMINS 0 2
Members: 620 874 782
2. Visual inspection with acetic acid 0 0 Ascorbic Acid 500mg. tablet 0 1
Dependents: 162 1498 2372 3. Regular BP measurements 323 497 Multivitamin Tablet 0 3
TOTAL 1494 1660 3154 4. Breastfeeding program education 8 64 AMBROXOL 30 mg TABLET 7 13
5. Periodic clinical breast examination 27 200 AMBROXOL 30MG/ML 0 2
Number 6. Counselling for lifestyle modification 312 482 Multivitamins syrup 0 2
VIII. 10 Common
of 7. Counceling for smoking cessation 241 249 CEFALEXIN 500mg Capsule 0 1
Illnesses (Morbidity)
Cases 8. Body Measurements 320 501 Cetirizine 10mg. tablet 1 0
Haemophilus influenzae infection, 9. Digital rectal examination 0 0 II. AGE with no or mild dehydartion
unspecified (INFLUENZA DUE TO H. 167 Diagnostics Examinations VITAMINS 0 2
INFLUENZAE) Metronidazole 500mg 0 2
1. Complete blood count (CBC) 5 11 0 0
Acute upper respiratory infection, Cefalexin 500mg cap 0 2
unspecified (Acute Upper Respiratory Tract 85 2. Urinalysis 6 25 0 0
Metronidazole 500mg 12 42
Infection, VIRAL) 3. Fecalysis 3 9 0 0
Aluminum Hydroxide Magnesium
Scabies 78 4. Sputum Microscopy 35 41 0 0 2 3
Hydroxide
HYPERTENSION, STAGE I 75 5. Fasting blood sugar (FBS) 71 45 0 0 Loperamide 2mg. tablet 0 3
Urinary tract infection, site not specified 6. Lipid profile 0 1 0 0 Multivitamins Syrup 0 2
(GENITO URINARY TRACT INFECTION 62
7. Chest x-ray 1 3 0 0 Metronidazole 125mg/5mL
(GUTI) (Urosepsis) 0 4
suspension, 60mL
Infectious gastroenteritis and colitis,
Multivitamins syrup 0 4
unspecified (ACUTE BLOODY DIARRHEA,
ACUTE GASTROENTERITIS, ACUTE WATERY Cefalexin 250 mg susp 0 7
DIARRHEA, ENTERITIS, Dysentery) CEFALEXIN 250/5ml Suspension 60ml 0 2
61
(INFECTIOUS DIARRHEA/DIARRHEA CEFALEXIN 100mg/ml drops 15ml 0 1
W/DEHYD, LEVEL OF DEHYDRATION NOT COTRIMOXAZOLE 800MG 2 7
SPEC, III. URTI/Pneumonia (minimal & low risk)
W/MILD,SOME,MODERATE,MARKED,SEVERE) Amoxicillin 250mg 0 3
Essential (primary) hypertension 59
VITAMINS 0 1
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Acute amoebic dysentery 56 Cefalexin 500mg cap 2 1
(AMOEBIC/AMOEBIASIS COLITIS) Ascorbic Acid 500mg. tablet 1 4
(INTESTINAL AMOEBIASIS) Symdex Tablet 1 1
Influenza due to identified influenza virus 52 AMBROXOL 30 mg TABLET 14 25
Cough 52
Cotrimoxazole 800mg 2 5
AMBROXOL 30MG/ML 1 2
Ascorbic Acid Syrup 0 7
Paracetamol 125mg Syrup 0 1
Symdex Tablet 2 1
Cotrimoxazole 400mg 0 2
Paracetamol 500 mg tab 0 7
CEFALEXIN 250/5ml Suspension 60ml 0 1
Amoxicilin 500mg Capsule 3 5
COTRIMOXAZOLE 800MG 21 21
Cefalexin 500mg cap 8 9
IV. UTI
Amoxicillin 250mg 0 1
Ciprofloxacin 500mg 9 42
Cotrimoxazole 800mg 0 1
Cloxacillin 125mg susp 0 1
Cefalexin 250 mg susp 0 1
CEFALEXIN 250/5ml Suspension 60ml 0 1
COTRIMOXAZOLE 800MG 0 2
Cefalexin 500mg cap 0 6
V. Nebulisation Services
Ferrous Sulfate Tabs.(eq.60mg.
element.Iron)200mg + 400mcg. Folic 0 1
Acid

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