DEPARTMENT OF HEALTH: Metro Manila Center for Health Development
BASELINE DATA
REPORTING FORM
1. Facility Type: ___________
2. What is the total # of ambulance or patient transport vehicle for suspect, probable or confirmed
cases in the hospital? ___________
3. What is the # of ICU beds with negative pressure for COVID-19 patients (suspect, probable,
confirmed) in the hospital? _________
4. From Feb 1 to April 15, 2020, how many PUI’s / suspect or probable COVID-19 have DIED? _____
5. From Feb 1 to April 15, 2020, how many confirmed COVID-19 DIED? _______
6. From Feb 1 to April 15, 2020, how many confirmed COVID-19 RECOVERED? ________
Out of your health care workers who DIED due to COVID-19 (suspect, probable, or confirmed)
from Feb 1 to April 15 in the hospital, what is the….
7. # of doctors? _______
8. # of Nurses? _________
9. # of other staff? ______
Out of the health care workers (plantilla / JO excluding augmented personnel) serving COVID-19
patients (suspect, probable, confirmed) in a single shift, what is the…
10. # of intensive care, infectious disease, pulmonologist specialist: _______
11. # of other doctors (including residents) _________
12. # of nurses: _______
13. # of medical technologist: ___________
14. # of respiratory therapist: ________
15. # of radiologic technologist: __________
16. # of other staff: _________
Out of the health care wo0rkers (plantilla / JO, excluding augmented personnel) serving COVID-
19 patients (suspect, probable, confirmed) in the ICU in a single shift, what is the …
17. # of intensive care, infectious disease, pulmonologist specialist: ________
18. # of other doctors (including residents): _________
19. # of nurses: _________
20. # of respiratory therapist: ________
21. # of other staff: _______
Out of the health care workers (plantilla/ JO, excluding augmented personnel), serving COVID-19
patients (suspect, probable, confirmed) in the ward is a single shift, what is the …
22. # of intensive care, infectious disease, pulmonologist specialist: ________
23. # of doctors (including residents): _________
24. # of nurses: ________
25. # of medical technologist: __________
26. # of respiratory therapist: ________
27. # of radiologic technologist: ________
28. # of other staff: ________
Out of the health care workers (plantilla / JO excluding augmented personnel) serving COVID-19
patients (suspect, probable, confirmed) in the TRIAGE area/s in a single shift, what is the …
29. # of other doctors (including residents): ________
30. # of nurses: ______
31. # of other staff: _______
As of January 31, 2020 (before COVID-19 pandemic), what was the TOTAL # of the following
health care workers (plantilla/ JO ) in the hospital for COVID-19 and non-COVID-19 cases, for all
shifts…
32. # of intensive care, infectious disease, pulmonologist specialists: ________
33. # of other doctors (including residents): ________
34. # of nurses: ________
35. # of medical technologist: _______
36. # of respiratory therapist: __________
37. # of radiologic technologist: ______
38. # of other staff: _______
What is the # of augmented personnel (hired through emergency hiring) in the hospital?
39. # of augmented personnel: ____________
KEY POINTERS:
The total number of consultants serving COVID19 patients in the ER, ICU and ward
should not exceed the total number of consultants in the hospital, please check entries
in 32, 10, 17 and 22
The total number of medical technologists serving COVID19 patients in the ER and wards
should not exceed the total number of medical technologist in the hospital, please check
entries in 35, 13, and 25
The total number of nurses serving COVID19 patients in the Triage, ER, ICU and wards
should not exceed the total number of nurses in the hospital, please check entries in
34,12,19,24, and 30
The total number of radiologic technologists serving COVID19 patients in the ER, and
wards should not exceed the total number of radiologic technologists in the hospital,
please check entries in 37, 15, and 27
The total number of resident doctors serving COVID19 patients in the Triage, ER, ICU
and wards should not exceed the total number of resident doctors in the hospital,
please check entries in 33, 11, 18, 29, 23
The total number of respiratory therapists serving COVID19 patients in the ER. ICU and
wards should not exceed the total number of respiratory therapists in the hospital,
please check entries in 36, 14, 20 and 26
The total number of support staff serving COVID19 patients in the Triage, ER, ICU and
wards should not exceed the total number of support staff in the hospital, please check
entries in 38, 16, 21, 28 and 31.
