HOW TO FILL-UP THE SDN REGISTRY MATRIX

Column # Name Description

1 Name of SDN Identify the name of the network
Primary Care Service Facilities (PCSF)
2 Profile of Member Health Facilities (RHU/HC/UHC)

Identify the Rural Health Unit (RHU)/Health Center (HC) /Urban Health Center (UHC)
2.1 Name of RHU/HC/UHC /PF within each network; identification must be consistent with the National Health Facility
Registry
2.2 Total Population Indicate the total catchment population of each RHU/HC/UHC

2.3 Number of Barangays Indicate the total number of barangays served within its catchment area

2.4 Number of BHS Indicate the total number of Barangay Health Station (BHS) within its catchment area

2.5 PhilHealth Accreditation Status of accreditation, i.e., PCB, TB DOTS, MCP, ABP, OMP, NCP

2-Jun With Existing EMR? Specify name of information system currently used by the RHU/HC/UHC, if any

3 Travel Information Details From RHU/HC/ UHC to RF

3.1 Mode of Transportation

Provide the different mode of transportation (tricycle, jeep, ambulance, car, plane, etc.,),
distance (in Km) and average travel time (hours/minutes) from the RHU/HC/UHC to
3.2 Distance (Km) Referral Facility (RF)
3.3 Average Travel Time

Specify the instrument used by the Rural Health Unit (RHU)/Health Center (HC) /Urban
Health Center (UHC) as a mode of engagement with the Referral Facility. Instrument may
4 Instrument of Engagement
be in the form of Service Provider Agreement (SPA), Memorandum of Agreement (MOA),
etc

Profile of Referral Facility (The referral facility of RHU/HC/UHC/PF may include Level 1 or 2 Hospital. If the RHU/HC/UHC/PF is
5
within the proximity of the identified Apex Hospital, there is no need to fill-out this section)

Identify the name of the Referral Facility; identification must be consistent with the
5.1 Name of the Referral Facility
National Health Facility Registry

5.2 Type Indicate the type/category of facility, Level 1 or Level 2

5.3 Ownership Indicate nature of ownership of the facility, government or private

5.4 With Existing EMR? Specify name of information system currently used by the Referral Facility, if any

Apex Hospital (AP): any Level 3 DOH Hospital within the proximity of the PCSF

6 Travel Information Details From RF to AP

6.1 Mode of Transportation

Provide the different mode of transportation (tricycle, jeep, ambulance, car, plane, etc.,),
6.2 Distance (Km) distance (in Km) and average travel time (hours/minutes) from the Referral Facility (RF) to
Apex Hospital (AP)
6.3 Average Travel Time

Specify the instrument used by the Referral Facility as a mode of engagement with the
7 Instrument of Engagement Apex Hospital (AP). Instrument may be in the form of Service Provider Agreement (SPA),
Memorandum of Agreement (MOA), etc

8 Name of Apex Hospital Identify the name of the Apex Hospital

9 With Existing EMR? Specify name of information system currently used by the Apex Facility, if any
 SDN REGISTRY MATRIX SDN REGISTRY MATRIX

Name of MUNICIPALITY: IPIL

PRIMARY CARE SERVICE FACILITIES (PCSF) PRIMARY CARE SERVICE FACILITIES (PCSF) APEX HOSPITAL (AH)
TRAVEL INFORMATION
DETAILS
TRAVEL INFORMATION DETAILS
PROFILE OF MEMBER HEALTH FACILITIES PROFILE of Referral Facility (RF) with
with (RF TO AH) existing
Name of SDN (5) existi Instrumen
[Rural Health Units (RHU) / Health Centers (HC) / Urban Health Centers (UHC)] From RHU/HC/UHC to RF Instrument of EMR?
t of
Name of (2) with (3) Engagement ng
Engagem
Name of AH (If yes,
RHU/HC/UHC existin with RF EMR (6) please
(1) g ? (If ent with
Number PhilHealth Accreditation (2.5) Distan specify)
Numbe EMR? Average Name of RF Type yes, Mode of AH
(2.1) Total of Outp ce Travel (8)
r of Anim (If yes, Distance Travel Time (4) Ownership pleas Transport
Populati Barang atient Mode of (km) Time (7)
BHS Primary Care al please (km) (Hours & (G or P) e
on ays Maternal Care Malar Newborn Care specify) Transport (3.1)
Benefit TB DOTS Bite (3.2) Minutes ) (5.3) specif (9)
(2.2) Package ia Package (6.3)
(2.4) Package Pack (3.3) (5.1) (5.2) y) (6.1)
(2.3) Pack (6.2)
age
age
(2.6) Rescue Vehicle De Villa Private
Hospital
IPIL MUNICIPAL YES MOA LEVEL Rescue 140 2 Referral Zamboanga
(5.4)
82,070 28 14 P09025309 T09004328 M09017714 N/A N/A M09017714 Misu 1 km 5-10 mins. M.Simon City Medical
HEALTH OFFICE Tricycle 1 Private Vehicle km hours Form
WAH Hospital Center
Referral Form ZSPH Government

less than 1
BHS POBLACION 8,128 2 1 Tricycle km 5-10 mins. Referral Form RHU IPIL Government

BHS PANGI 4,423 2 1 Tricycle/Jeep 3 km 10 mins. Referral Form RHU IPIL Government
BHS TENAN 4,074 2 1 Tricycle/Jeep 7 km 45 mins. Referral Form RHU IPIL Government
BHS MAGDAUP 9,826 2 1 Tricycle 3.5 km 20 mins. Referral Form RHU IPIL Government
IPIL, BHS TAWAY 4,921 2 1 Tricycle, Jeep 2.5 km 30 mins. Referral Form RHU IPIL Government
ZAMBOAN
GA BHS LUMBIA 2,863 2 1 Habal- Habal 12 km 25 mins. Referral Form RHU IPIL Government
SIBUGAY
PROVINCE BHS TIAYON 4,079 2 1 Tricycle, Habal- 6 km 20 mins. Referral Form RHU IPIL Government
Habal
BHS LABE 2,335 2 1 Habal- Habal 9 km 15 mins. Referral Form RHU IPIL Government
BHS MAKILAS 3,566 2 1 Tricycle,Jeep 8 km 30 mins. Referral Form RHU IPIL Government
BHS DON ANDRES 6,684 1 1 Tricycle 1 km 8 mins. Referral Form RHU IPIL Government

BHS BULUAN 4,837 2 1 Tricycle,Rescue 10 km 40 mins. Referral Form RHU IPIL Government
Vehicle

BHS BACALAN 2,982 3 1 Tricycle,Rescue 11 km 30 mins. Referral Form RHU IPIL Government
Vehicle
BHS VETERANS 12,314 2 1 Tricycle 3 km 15 min. Referral Form RHU IPIL Government
BHS SANITO 10,460 2 1 Tricycle 2 km 5 mins. Referral Form RHU IPIL Government

PREPARED BY: APPROVED BY:

CHERYLANE L. TEVES ADNILRE D. VERZON, MD

PHA MHO

3 of 7
Name of Province: SURIGAO DEL NORTE

PRIMARY CARE SE
PROFILE OF MEMBER HEALTH FACILITIES
[Rural Health Units (RHU) / Health Centers (HC) / Urban Health Centers (UHC)/Private Facilities]
Name of SDN
(1) PhilHealth Accreditation (2.5)
Total Number of Number of
Name of RHU/HC/UHC
Population Barangays BHS
(2.1) Primary Care
(2.2) (2.3) (2.4) Maternal
Benefit TB DOTS
Care Package
Package

CLAVER RURAL HEALTH UNIT 32773 14 11

GIGAQUIT RURAL HEALTH UNIT 20864 13 6
Sample 1 CLAGIBA
BACUAG RURAL HEALTH UNIT 14486 9 4

SURIGAO CITY HEALTH OFFICE

TAFT DISTRICT HEALTH CENTER

154137 95 29
SAN JUAN DISTRICT HEALTH CENTER
Sample 2 SUSAMA

LUNA DISTRICT BIRTHING HOME AND TB DOTS CENTER

WASHINGTON DISTRICT HEALTH CENTER

SAN FRANCISCO RURAL HEALTH UNIT AND BIRTHING

14552 11 6
FACILITY
MALIMONO RURAL HEALTH UNIT AND BIRTHING FACILITY 18054 14 5

Instructions in Accomplishing the Form

Column No. Column Name How to Fill Out the Column
1 Name of SDN Identify the name of the SDN
2.1 Name of RHU/HC/UHC List the Rural Health Units (RHU)/Health Centers (HC)/Urban Health Centers (UHC) under the SDN
2.2 Total Population Identify the total catchment population of each RHU/HC/UHC
2.3 Number of Barangays Indicate the number of catchment Barangays of each RHU/HC/UHC
2.4 Number of BHS Indicate the number of catchment Barangay Health Station (BHS) of each RHU/HC/UHC
Indicate if the facility is PhilHealth-accredited for Primacy Care Benefit, TB DOTS, Maternal Care Package, Animal Bite Package, Outpatient Malaria Package, Newborn Care
2.5 PhilHealth Accreditation
Package. Check the appropriate cells
Existing Electronic Medical
2.6 Identify if the RHU/HC/UHC has existing Electronic Medical Record (EMR). If yes, kindly specify the EMR. If none, please leave the cell blank
Record (EMR)

3.1 Mode of Transport Determine the usual mode of transportation (i.e. tricycle, ambulance, Barangay patrol) from the RHU/HC/UHC to its PCSF referral facility

3.2 Distance (km) Determine the approximate distance from the RHU/HC/UHC to its PCSF referral facility
3.3 Average Travel Time Determine the average travel time from the RHU/HC/UHC to its PCSF referral facility

Instrument of Engagement Specify the instrument of engagement between the RHU/HC/UHC and the PCSF referral facility (i.e. MOA, SPA, Referral Manual, MOU, COC, pledge of cooperation)
4
with RF *If the referral facility of the RHU/HC/UHC is the identified apex hospital, leave this column blank

Indicate the name of the PCSF referral facility of the RHU

5.1 Name of RF
*If the referral facility of the RHU/HC/UHC is the identified apex hospital, leave this column blank

Specify the type of health facility (i.e. hospital, infirmary, laboratory, ambulatory clinic etc.)
5.2 Type
*If the referral facility of the RHU/HC/UHC is the identified apex hospital, leave this column blank

Specify the type of ownership of the referral facility (i.e. government, private)
5.3 Ownership
*If the referral facility of the RHU/HC/UHC is the identified apex hospital, leave this column blank

Existing Electronic Medical Identify if the RF has existing Electronic Medical Record (EMR). If yes, kindly specify the EMR. If none, please leave the cell blank
5.4
Record (EMR) *If the referral facility of the RHU/HC/UHC is the identified apex hospital, leave this column blank

Determine the usual mode of transportation (i.e. tricycle, ambulance, Barangay patrol, boat, airplane) from the PCSF referral facility to its Apex Hospital
6.1 Mode of Transport
*If the referral facility of the RHU/HC/UHC is the identified apex hospital, leave this column blank
Determine the approximate distance from the PCSF referral facility to its Apex Hospital
6.2 Distance (km)
*If the referral facility of the RHU/HC/UHC is the identified apex hospital, leave this column blank
Determine the average travel time from the PCSF referral facility to its Apex Hospital
6.3 Average Travel Time
*If the referral facility of the RHU/HC/UHC is the identified apex hospital, leave this column blank
 SDN REGISTRY MATRIX

RY CARE SERVICE FACILITIES (PCSF)

TRAVEL INFORMATION
PROFILE of Referral Facility (RF)
From RHU/HC/UHC to RF (5)
(2)
(3)
INSTRUMENT OF
ENGAGEMENT
h Accreditation (2.5) with WITH RF with
existing Average existing
Ownership
EMR? (If Mode of Distance Travel Time Type EMR? (If
Name of RF (G or P)
yes, please Transport (km) (Hours & (4) yes, please
Outpatient Newborn specify) (5.1)
Animal Bite (3.1) (3.2) Minutes ) (5.2) specify)
Malaria Care (5.3)
Package (3.3)
Package Package (2.6) (5.4)

AMBULANCE 11 11M MOA

AMBULANCE 3.4 7M MOA
GIGAQUIT DISTRICT HOSPITAL INFIRMARY G
AMBULANCE 10.7 13M MOA

AMBULANCE CARAGA REGIONAL HOSPITAL HOSPITAL G

1.2 6M MOA
AMBULANCE SURIGAO MEDICAL CENTER INC HOSPITAL P

BRGY. PATROL CARAGA REGIONAL HOSPITAL HOSPITAL G

1.4 6M MOA
BRGY. PATROL SURIGAO MEDICAL CENTER INC HOSPITAL P

BRGY. PATROL CARAGA REGIONAL HOSPITAL HOSPITAL G

1 5M MOA
BRGY. PATROL MIRANDA FAMILY HOSPITAL HOSPITAL P

AMBULANCE CARAGA REGIONAL HOSPITAL HOSPITAL G

3.7 13M MOA GRACE-CHRISTIAN CLINIC AND
AMBULANCE HOSPITAL P
HOSPITAL

AMBULANCE 6.7 16M MOA

CARAGA REGIONAL HOSPITAL HOSPITAL G

AMBULANCE 11.6 23M MOA

AMBULANCE 31.7 57M MOA

 APEX HOSPITAL (AH)
TRAVEL INFORMATION DETAILS

(RF TO AH)
(6)
with existing
Mode of Formal EMR? (If yes,
Name of AH
Engagement with AH please specify)
(8)
Distance (7)
Mode of Transport Travel Time (9)
(km)
(6.1) (6.3)
(6.2)

AMBULANCE 52.8 - 61.1 1H 7M - 1H 35M MOA CARAGA REGIONAL HOSPITAL

AMBULANCE + AIRPLANE 253 3H MOA VICENTE SOTTO MEMORIAL MEDICAL CENTER

AMBULANCE 6.8 14M MOA

AMBULANCE 6.8 14M MOA

CARAGA REGIONAL HOSPITAL

AMBULANCE 0.55 2M MOA

AMBULANCE 1.4 6M MOA

 Specify the instrument of engagement between the PCSF referral facility and the Apex Hospital (i.e. MOA, SPA, Referral Manual etc.)
7 Formal Engagement with AH
*If the referral facility of the RHU/HC/UHC is the identified apex hospital, leave this column blank
8 Apex Hospital Indicate the name of the Apex Hospital
Existing Electronic Medical
9 Identify if the AH has existing Electronic Medical Record (EMR). If yes, kindly specify the EMR. If none, please leave the cell blank
Record (EMR)