INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) 

I, ​AUBREY JANE F. GADOR, RMT​, of the Department of Health Regional Office X, commit to deliver and agree to be rated 
on the attainment of the following targets in accordance with the indicated measures for the period of OCTOBER TO DECEMBER 
2019. 
 
​Date: ​NOVEMBER 22, 2019 

Approved by:  Date 

ALMA G.CABUDOY,RN, MAN

DMO IV 
 SUCCESS INDICATOR
Output Actual Accomplishment Rating Remarks
(Target + Measure) 
1​. Assist in the implementation   
of various health programs of 
the LGU in accordance with 
the program goals & 
objectives of DOH & Health 
Sector 
I. PRENATAL CARE    QTY  QLT  T  A 
(1) (2) (3) (4)

No. of pregnant women tested  _____ Urinalysis performed within 15minutes with 100%  _____ Urinalysis performed within 15minuteswith 
with Urinalysis.  accuracy.  100% accuracy.

No. of pregnant women tested  _____ HBsAg Rapid Screening Test performed within  _____ HBsAg Rapid Screening Test performed 
with HBsAg Rapid Screening Test.  20minutes with 100% accuracy.  within 20minutes with 100% accuracy.

No. of pregnant women tested  _____Syphilis Rapid Screening Test performed within  _____ Syphilis Rapid Screening Test performed 
with Syphilis Rapid Screening Test  20minutes with 100% accuracy.  within 20minutes with 100% accuracy.
II. PREVENTION AND CONTROL OF 
INFECTIOUS DISEASES 
No. of TB samples stained (AFB 
_____ TB sputum smear stained and examined within  _____TB sputum smear stained and examined 
Staining) and examined with 
1hour with 100% accuracy.  within 1hour with 100% accuracy. 
DSSM. 
IV. CHILD CARE 
No. of children tested for  _____ Urinalysis performed within 15minutes with 100%  _____ Urinalysis performed within 15minutes with 
Urinalysis.  accuracy.  100% accuracy. 
_____ Fecalysis performed within 15minutes with 100%  _____ Fecalysis performed within 15minutes with 
No. of children tested for fecalysis 
accuracy.  100% accuracy. 
2. Maintain laboratory 
 
facilities, supplies, and  Maintain cleanliness, proper waste disposal 
 
equipment in good working  implemented in the health facility. 
conditions at all time. 
3. Maintain and secure record  File patient records per month from 
 
of patients.  October-December with 90% easy retrieval. 

Maintain logbooks for laboratory results from 

   
October- December 2019 with 100% accuracy. 
4. Provide technical  Assist health workers in their patient’s laboratory 
assistance related to  referrals/requests form October-December 2019 with   
laboratory procedures.  90% effectiveness. 
5. Prepare, analyze and  Prepare and submit monthly reports on or before 
submit report as required by  due date from October-December 2019 with 100%   
DOH.  accuracy. 
6. Attend HRH Monthly  Attend 3 HRH meetings from October- December 
 
Meeting.  2019 with 100% participation. 
    TOTAL 
RATING
TOTAL OVER ALL RATING   
FINAL AVERAGE RATING           
ADJECTIVAL RATING     
COMMENTS AND RECOMMENDATION  
FOR DEVELOPMENT PURPOSES 
       

DISCUSSED WITH: ASSESSED BY: FINAL RATING BY:

DATE 
AUBREY JANE F. GADOR,RMT MARIFEL P. PANGA, RN, RMT RAMONA B. SANTIAGO, MD 
MTDP  CHIEF MEDICAL TECHNOLOGIST  MUNICIPAL HEALTH OFFICER

ALMA G.CABUDOY, RN, MAN

DMO IV 
SUPERVISOR