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  • Travel Order

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    Jocelyn Militar Amancio - Daproza
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    The document contains a special order from the Occidental Mindoro Provincial Hospital in the Philippines directing a nurse or doctor to transport a patient named [NAME] via ambulance to another location or hospital for further medical treatment and evaluation on a specified date. It also contains an accomplishment report template for the medical professional to document having conducted the transport of the named patient from one location to another, returning to their station on a given date after providing a diagnosis. Both the order and report are signed by the Chief of Hospital.

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    Original Title

    TRAVEL ORDER

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    The document contains a special order from the Occidental Mindoro Provincial Hospital in the Philippines directing a nurse or doctor to transport a patient named [NAME] via ambulance to another location or hospital for further medical treatment and evaluation on a specified date. It also contains an accomplishment report template for the medical professional to document having conducted the transport of the named patient from one location to another, returning to their station on a given date after providing a diagnosis. Both the order and report are signed by the Chief of Hospital.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    40 views2 pages

    Travel Order

    Uploaded by

    Jocelyn Militar Amancio - Daproza
    The document contains a special order from the Occidental Mindoro Provincial Hospital in the Philippines directing a nurse or doctor to transport a patient named [NAME] via ambulance to another location or hospital for further medical treatment and evaluation on a specified date. It also contains an accomplishment report template for the medical professional to document having conducted the transport of the named patient from one location to another, returning to their station on a given date after providing a diagnosis. Both the order and report are signed by the Chief of Hospital.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 2

    Republic of the Philippines

    PROVINCE OF OCCIDENTAL MINDORO


    Mamburao

    OCCIDENTAL MINDORO PROVINCIAL HOSPITAL


    Philhealth Accredited

    ____________
    (Date)

    PROVINCIAL)
    Special Order:
    No. s., 2020

    Mr. / Ms. / Dr. ___________________________________,_______________________ of this


    (Name of Nurse/Doctor) (Position)

    Office is hereby directed to proceed to ____________________________________________to


    (Place/Hospital)
    conduct __________________________________for further medical, treatment and evaluation
    (Name of Patient)

    thereat on _______________________.
    (Date)

    Name of Driver:____________________________

    With Ambulance Plate No. ___________________

    This Order, being in the interest of the service is hereby declared official and made of record.

    REYNALDO A. FERATERO, MD, FPCS


    Chief of Hospital
    Approved by:

    EDUARDO B. GADIANO
    Provincial Governor

    MURIEL M. REGUINDING
    Provincial Administrator

    Bgy. Tayamaan, Mamburao, Occ. Mdo; Email: omph_mamburao@yahoo.com; Mobile Nos.: 0956-420-2343/0946-741-3214; Tel. No. 043-711-3020
    Republic of the Philippines
    PROVINCE OF OCCIDENTAL MINDORO
    Mamburao

    OCCIDENTAL MINDORO PROVINCIAL HOSPITAL


    Philhealth Accredited

    ACCOMPLISHMENT REPORT
    Occidental Mindoro Provincial Hospital
    Date:

    Last ________________, I conducted patient__________________, _______years old, from


    _____________________________to _______________________________________with a
    Diagnosis of__________________________________________________________________
    ____________________________________________________________________________

    I returned to my station on ____________________.

    Prepared by

    ______________________________

    Noted by:

    REYNALDO A. FERATERO, MD, FPCS


    Chief of Hospital

    Bgy. Tayamaan, Mamburao, Occ. Mdo; Email: omph_mamburao@yahoo.com; Mobile Nos.: 0956-420-2343/0946-741-3214; Tel. No. 043-711-3020

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