Certain routine service protocols and procedures have to be followed by the clients in order to avail health services. These procedures depend on the nature of clients’ concerns particularly whether their needs are emergency in nature or not. In general the following steps should be followed by the clients:

1.            For non-emergency consultation/medical services which include regular follow up, regular check up, blood pressure monitoring request for laboratory examinations,  minor surgical procedures resulting from non-traumatic event such as removal of foreign body, inflammation of body parts (abscesses), wound debridement etc., pre-natal check up, family planning services, immunization and vaccination, consultation for treatment of common illnesses etc.

                a.            proceed to the barangay health station where you (client) presently reside.

                b.            discuss with the rural health midwife (RHM)on duty your concerns/illness for initial screening. A patient record will be accomplished by the RHM and management will be recorded on this. The RHM’s can treat and manage simple and uncomplicated cases based on “Integrated Management of Childhood Illnesses” training.

                c.             If necessary the RHM will refer the client to the main health center of the rural health unit for assessment of the rural health physician. The doctor will then place into record all the treatment and management including follow up schedules and this will be carried out by the concerned staff in the main health center.

                d.            The patient/client will then bring his/her record back to the barangay health station where he/she resides. During follow ups or consultation for another illness this same general routine procedures applies.

                It should be emphasized that the health centers entertain clients on a fist come first serve basis except during emergencies.  Express lanes are also established for senior citizens and differently abled persons. Furthermore clients are advised to seek medical consultation in the morning only to give time for the other services, duties and obligations of the rural health physician and other staff which are usually carried out in the afternoon.

                Medical consultations are available at the main health centers from Mondays thru Fridays 8:00 am until 5:00 pm. Rural Health Physicians are also task to conduct barangay visits at least two times a week to see patients who cannot for whatever circumstances go to the main health centers.

2.            Dental services

                a.            proceed to the barangay health station where you (client)presently resides

                b.            Discuss your concern to the RHM on duty. A record will be accomplished and the client will be referred to the Rural Health Dentist at the main health center in the unit.

                c.             The dentist will do the oral care services and give necessary treatment and advise to the client. Dentist’s orders are put into record and shall be carried out by the staff in the main health center.

                d.            The patient shall return his/ her record at the barangay health center. These procedures apply everytime a dental consultation is being sought.

                The Rural Health Dentists just like the Rural Health Physicians do barangay visits to reach out for the patients who cannot go to the main health centers for dental check up.

3.            Immunization/Vaccination

                Immunizations and vaccinations are done at the Barangay Health Stations except for some type of vaccinations where clients will be referred to the main health centers. Immunizations and vaccinations are scheduled routinely depending on the type of vaccination a child is scheduled to receive. Certain immunizations are only done once a week at the main health centers. For a more detailed procedure on immunization please see our rural health midwife assigned in your barangays.

                Once in awhile the rural health midwives with the barangay health workers do house to house visits and immunize those who have missed their schedules. This is to make sure that 100% of the actual target population in Mariveles have been given essential vaccinations as identified by the Department of Health.

4.            Medical Certificates/Signing of SSS sickness notification/Physical examinations

                Medical /Dental certificates are issued by the Rural Health Physicians/Rural Health Dentists on a case to case basis. Issuance of these certificates are subject to legal procedures generally accepted in the medical field. No clients shall be given a medical certificate unless he/she has been examined by the physician or by the dentists. It is advised by the Municipal Health Office that clients who are working in companies who employ a company or retainer physician seek consult with their respective company physicians especially those who need medical certificates which will be utilized as reference for sickness leaves.

                Sickness notifications for SSS claim purposes may be signed by the rural health physician only if the client has been attended to by the physician.

                Physical examination for purposes of employment may be granted if agreeable with the hiring company or employer but subject to the requirements set by the municipal health office provided that the required laboratory examinations are done by duly licensed medical laboratories and clinics other than the Municipal Health Office. Laboratory examinations available at the Municipal Health Office are generally intended for patients and not for routine physical examinations for pre-employment.

                Physical examination of pupils/students for athletic competitions or camping and related activities should be well coordinated by the sending school with the rural health physician at least two weeks for scheduling. This is to make sure that the students and pupils are well examined and will be attended to and to make sure that the other activities of the rural health physician are not compromised. “Walk –in” cases may be entertained depending on the availability of the physician and the number of students required to undergo physical examination. Forms should be provided by the sending school completely accomplished by the students’ parents or guardians.

5.            Medico-legal services

                Procedures for medico-legal services follow the same steps as that of a regular consultation except that in times when time constraint is at hand, these services may be sought at the 24 hours Emergency and First Aid Satellite Clinic whenever the physician in charge is available. No medico-legal procedures nor examinations will be entertained at the residence or homes of the rural health physicians unless he/she approves to it. This holds true with physical examinations required prior to inquest proceedings.

                Post mortem examinations are only conducted during office hours unless a rural health physician agrees to do the examination even after office hours. No post mortem examination will be conducted without the presence of a police officer. Post mortem examinations are only conducted for deaths with medico-legal issues. Medico-legal examination for rape cases is not within the capabilities of the rural health physicians. These cases will be referred to higher government health service facilities with obstetrician-gynecologists or to the National Bureau of Investigation. The Rural Health Physicians have the option to refuse conduct of medico-legal/post mortem services subject to the provisions on medical ethics and legal medicine.

6.            Physical/Behavioral Rehabilitation/Therapy Services

                To seek rehabilitation services a client needs to proceed to the Dong In Tulay Center (DITC)and have himself/herself scheduled for appointment with the DITC consultants for evaluation and assessment. Once scheduled for check up with the consultants the client is then given a therapy regiman that will be carried out by the therapists in accordance with the orders from the consultants. The physiatrist (rehabilitation physician) visits the DITC once a week (every Tuesdays) from 9:00 am until all scheduled clients have been evaluated. Further follow up with the consultant is necessary upon his orders to determine progress of rehabilitation. The child psychologist, speech therapist and occupational therapist visit the DITC once a month.

7.            Issuance of Sanitary Permits

                As a pre-requisite for business permits and mayors permits the municipal health office is tasked to inspect the sanitation condition of every establishment covered by law to secure permits and licenses. In general all employed food handlers in Mariveles are required to undergo laboratory examinations such as chest x-ray and stool examinations. These health certificates are valid only for six months and should be renewed every six months thereafter. Chest x-ray examinations are however required only to be submitted once a year.

                A sanitary permit is only issued upon compliance with all the requirements set by the Local Government Unit in accordance with its ordinances and revenue code. A barangay business clearance, zoning clearance and satisfactory sanitation inspection report ( health certificates for establishments with employed food handlers or establishments serving food and food products)are pre-requisites for issuance of sanitary permits.

                Sanitary permits are renewable every first quarter of the year and are revocable upon violation of sanitation code of the Philippines and the Mariveles Code of Sanitation.

8.            Issuance of transfer Cadaver/Exhumation Permits

                Cadaver transfer and exhumation permits may be secured from the rural sanitation inspectors assigned in the unit where the requesting party is residing or in case for exhumation where the deceased is buried. A copy of the death certificate is required for review prior to issuance of these permits. All recommendations noted in the permits should be strictly complied with by the requesting party.

9.            Accomplishment of Death Certificates/Birth Certificates

                Death certificates signed by private physicians are subject to review by the municipal health officer/rural health physician. Deaths that occurred at home without being attended to by any physician may be signed by the municipal health officer/rural health physician provided that it will be indicated that the patient has not been attended to at the time of death. Furthermore the causes of death are understood to be only “as ascertained”. Relatives present at the time of death shall give information on the circumstances of death.  Signing of death certificates are done at the main health centers covering the residence of the deceased.

                Birth certificates are accomplished and registered at the local civil registry by the birth attendant or the rural health midwife within 24 hours after delivery. No birth certificates shall be signed by any health worker unless he/she attended to the client at the time of birth. All birth certificates should be reviewed by the parents prior to registration to avoid errors in the information written at the form.

10.           Birthing Home/BEmONC Services

                As of this date (April 25, 2012) the Basic Emergency Obstetric and Newborn Care (BEmONC) commonly known as a birthing home is yet to be operational. However this is expected to become fully operational in the year 2013. Service and operational protocols have been drafted as of today. This building will deliver services concerning maternal and child health care more particularly NSD (Normal Spontaneous Delivery). 

                Only normal deliveries and pregnancies without risks and complications will be managed at this building. Risks and complications are defined on Department of health and Municipal Health Office guidelines and Policies. Examples of pregnancies that cannot be attended to are first pregnancies, pregnancies with concomitant chronic or metabolic medical illness, previous caesarean section, complicated pregnancies and labor, 4 th pregnancy or more , pre-term labor etc.

11.          Laboratory/Ultrasound/Radiology (x-ray) services

                Laboratory and other ancillary services such as ultrasound and x-rays need approval from a rural health physician. This is to ensure the need for the requested examinations and to determine indication for the test. Clients who wish to undergo these examinations must first consult with the rural physician following the general procedures and secure requests for examinations. The RHP’s only issue request if necessary. Routine examination as pre-requisites for employment is not generally carried out in MHO laboratory unless approved by the rural health physician or the municipal health officer. Schedules of examination are as follows:

Blood Chemistry        Tuesdays and Wednesdays
Microscopy (Urinalysis/fecalysis/CBC)        as requested by the RHP
Ultrasound services        Wednesdays (with prior appointment schedule)
         Results are made available right after the procedure
X-ray        anytime during office hours if emergency
         Daily except Wednesday and Thursday
         Results are available only every Wednesday afternoon
ECG        daily except Wednesdays

These schedules may from time to time be modified depending on the number of clients and the need for its revision. Clients are advised to seek early appointment to avoid inconveniences in schedules and for pre –examination instructions.

12.          Emergency Services

                Any emergency case which is within the capabilities of MHO staff with consideration of available facilities, supplies and equipments will be attended to anytime at the 24 – Hours Emergency and First Aid Clinics. Referrals to higher facilities will be facilitated by all means if necessary. Initial screening by the RHM’s in barangay health stations is no longer necessary for emergency cases. The Municipal Health Office also responds to disasters and calamities whenever necessary. Every time available the Maraiveles Paramedics responds to vehicular accidents that are being reported to the office.

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