Republic of the Philippines

PROVINCE OF ILOCOS NORTE

Provincial Government of Ilocos Norte

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) FORM

I, MARK EMIL U. BAUTISTA of the PIDDIG DISTRICT HOSPITAL, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the
indicated measures for the period January 3 to June 30, 2022.

MARK EMIL U. BAUTISTA

Ratee
January 03, 2022
Date
Reviewed by Date Approved by Date

TITO HAMIR A. TONGSON, RN January 04, 2022 CHONA STELLA F. RABANG, MD January 5, 2022
Immediate Supervisor Head of Office

Rating Scale
5- Outstanding
4- Very Satisfactory
3- Satisfactory
2- Unsatisfactory
1- Poor

Success Indicators Actual Rating

Major Final Output (Targets + Measures) Accomplishments Q E T A Remarks
Core Functions
Provision of direct nursing care to in-patients 90-94% of in- patients provided with Provided direct nursing care to 315 in-
direct nursing care within 31-45 patients within 12 minutes with 0
minutes upon doctor’s order with not negative feedback
more than 4-6 negative 5 5 4 4.67
feedbacks/complaints from patients

Provision of service to out-patients
90-94% of out-patients serviced within
10-15 minutes from receipt of personal
data/history with not more than 4-6
negative feedbacks/complaints from
patients
Provided service to 1486 out-patients
within 5 minutes from documenting
of patient data/history with 1
negative feedback 4 5 5 4.67
Conduction of referred patients to higher level 90-94% of referred patients conducted Conducted 19 referred patients to
facility with not more than 3-4 minor higher level facility with 0 complaint 5 5 NTR 5.00
complaints received from patients
 Strategic Functions
NO ASSIGNED TASK
Support Functions
Nursing Service work scheduler 100% of regular work schedules prepared Prepare and encode 12 nurses schedules
with not more than 3-4 errors within the with 0 error within the prescribed time
prescribed time frame frame 5 5 5 5.00

AVERAGE RATING
Category MFO Rating
Core Functions 4.78 4.30
Support Functions 5.00 0.50
Strategic Functions NONE 0
Total Overall Rating 4.80
Final Average Rating 4.80
Adjectival Rating VERY SATISFACTORY

Comments/Recommendations for Development plan:

TO ATTEND HEMS, EMT TRAINING
TO ATTEND INFECTION CONTROL AND PREVENTION TRAINING
TO ATTEND ACLS TRAINING

Discussed with Assessed by Final Rating by

I certify that I discussed my assessment of the
performance with the employee.

MARK EMIL U. BAUTISTA TITO HAMIR A. TONGSON, RN CHONA STELLA F. RABANG, MD

Employee Supervisor Head of Office
Date: July 1, 2022 Date: July 2, 2022 Date: July 3, 2022
 Republic of the Philippines
PROVINCE OF ILOCOS NORTE
Provincial Government of Ilocos Norte

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) FORM

I, MARK EMIL U. BAUTISTA of the PIDDIG DISTRICT HOSPITAL, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the
indicated measures for the period July 01- December 31, 2022.

MARK EMIL U. BAUTISTA

Ratee
July 01, 2022
Date
Reviewed by Date Approved by Date

TITO HAMIR A. TONGSON, RN July 01, 2022 CHONA STELLA F. RABANG, MD July 02, 2022
Immediate Supervisor Head of Office

Rating Scale
5- Outstanding
4- Very Satisfactory
3- Satisfactory
2- Unsatisfactory
1- Poor

Success Indicators Actual Rating

Major Final Output (Targets + Measures) Accomplishments Q E T A Remarks
Core Functions
Provision of direct nursing care to in-patients 90-94% of in- patients provided with Provided direct nursing care to 664 in-
direct nursing care within 31-45 patients within 10 minutes with 1
minutes upon doctor’s order with not negative feedback
more than 4-6 negative 4 5 5 4.67
feedbacks/complaints from patients

Provision of service to out-patients
90-94% of out-patients serviced within
10-15 minutes from receipt of personal
data/history with not more than 4-6
negative feedbacks/complaints from
patients
Provided service to 1728 out-patients
within 10 minutes from documenting
of patient data/history with 0
negative feedback 5 5 4 4.67
Conduction of referred patients to higher level 90-94% of referred patients conducted Conducted 25referred patients to
facility with not more than 3-4 minor higher level facility with 0 complaint 5 5 NTR 5.00
complaints received from patients
 Strategic Functions
NO ASSIGNED TASK
Support Functions
Nursing Service work scheduler 100% of regular work schedules prepared Prepare and encode 12 nurses schedules
with not more than 3-4 errors within the with 0 error within the prescribed time
prescribed time frame frame 5 5 5 5.00

AVERAGE RATING
Category MFO Rating
Core Functions 4.78 4.30
Support Functions 5.00 0.50
Strategic Functions NONE 0
Total Overall Rating 4.80
Final Average Rating 4.80
Adjectival Rating VERY SATISFACTORY

Comments/Recommendations for Development plan:

TO ATTEND HEMS, EMT TRAINING
TO ATTEND INFECTION CONTROL AND PREVENTION TRAINING
TO ATTEND ANTIMICROBIAL STEWARDSHIP TRAINING

Discussed with Assessed by Final Rating by

I certify that I discussed my assessment of the
performance with the employee.

MARK EMIL U. BAUTISTA TITO HAMIR A. TONGSON, RN CHONA STELLA F. RABANG, MD

Employee Supervisor Head of Office
Date: January 5, 2023 Date: January 9, 2023 Date: January 10, 2023