PC-015-0

January 2022

Republic of the Philippines

Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan

PATIENT SAFETY COMMITTEE

PATIENT IDENTIFICATION CHECKLIST

Area: ____________________________________ Date: _____________

PARAMETERS YES NO REMARKS

1. Is the patient wearing an ID band in accordance to
hospital policy?

2. Do the staff identify the patient correctly using at

least two identifiers before any procedure?

3. Are the patient’s pertinent data complete and

correct?

4. Are the patients with lack and/or no identification

properly identified following the hospital policy?

5. Are the patient’s at the Behavioral Medicine

identified following the hospital policy?

Accomplished by: Conformed by:

______________________________ _____________________________
PMC Officer of the Day Auditee

Date: __________________ Date: __________________