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NHFR 2024 Update Form

This document provides information about a new health facility in the Province of Nueva Ecija. It includes the facility name, type (Barangay Health Station), ownership (Government), location details, contact information, and status (Active). The facility head's name and designation are also listed, along with details on who prepared and validated the form at the LGU and PDOH levels.

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Escanor Holy Knight
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1K views3 pages

NHFR 2024 Update Form

This document provides information about a new health facility in the Province of Nueva Ecija. It includes the facility name, type (Barangay Health Station), ownership (Government), location details, contact information, and status (Active). The facility head's name and designation are also listed, along with details on who prepared and validated the form at the LGU and PDOH levels.

Uploaded by

Escanor Holy Knight
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Province of Nueva Ecija

Name of LGU:

New Facility

Update
*Check the BOX

GENERAL INFORMATION
Facility Name:
Facility Major
Health Facility
Type:
Health Facility Related
Health Facility: RHU, BHS, Super Health Center
Health Facility Related: CHO (Office, Administrative Matters:
No Consultations being conducted)

Health Facility Barangay Health Station


Type:
Rural Health Unit (Super Health Center)

City Health Office

Ownership Major
Classification: Government
Private
Street Name and #:
(if None: write N/A)
Building Name and #:
(if None: write N/A)
Region Name:
Province Name:
City/ Municipality
Name:
Barangay Name:
Zip Code:
CONTACT INFORMATION
Landline Number:
(if None: write N/A)
Mobile Number:
(if None: write N/A)
Email Number:
Official Website:
(if None: write N/A)
FACILITY HEAD
Last Name:
First Name:
Middle Name:
Designation:
GEOGRAPHICAL LOCATION (Use Google Maps)
Latitude:
Longitude:
OTHER STATUS
Status of Facility: Active
Inactive

Primary Care Facility:


PCF

Non-PCF

PREPARED BY (LGU)
Name of Head of Facility:
Contact Number:
Signature:
Date Prepared:
VALIDATED BY (PDOH)
Name of DOH Representative:
Signature:
Date Validated:
RECEIVED IN PDOH
Name:
Signature:
Date Received:
ENCODED BY (PDOH)
Name of Encoder: Clesther Jose M. Espinosa
Signature:
Date Encoded:

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