Reporting Year: 2023

THIS PORTION WILL BE ACCOMPLISHED BY LGU/MHO FOR THIS PORTION WILL BE ACCOMPLISHED BY
BARMM THE ASSIGNED DOH REPRESENTATIVE/IPHO
Indicator 6. EMR utilization for digitalized service delivery at Data Quality Assessment for Indicator 6.
public primary care facilities.
What to Check Count how
For baseline data collection. LGUs will not be rated many RHU/
HC/ BHS have
the component
EMR Component Number of Public 1. How many RHU/ HC.
PCF (RHUs/ HCs/ BHS have a functioning
BHS) that has the EMR system in the
EMR component: RHU/ BHS/ BHS?
1. Presence of Electronic Medical 2. How many RHU/ HC/
Record in the Rural Health Units/ BHS have the EMR
Health Centers/ Barangay Health used/ integrated on all
Stations* of the following work
processes:
2. Digitalization of Work Process: All
a. Initial registration
facilities integrated EMR usage into b. Pulling up records
their daily workflow of delivering the c. Recording of
services: consultation
a. Initial registration d. Recording of
b. Pulling up records diagnostic
c. Recording of consultation examinations*
d. Recording of diagnostic (applicable to
examinations* (applicable to RHUs/HCs only)
3. How many RHU/ HC.
RHUs/HCs only)
BHS generate FHSIS
3. Statistical Report Generation:
report through EMR?
FHSIS reports fully generated using
the EMR
Remarks (Write a short explanation for
*List /Name the type of EMR present in the LGU: items answered “No”. Record any
___________________________________________ implementation issues encountered):
__________________________________
A. Number of public primary
__________________________________
care facilities (e.g. RHU, HC)
within the LGU that HAS MET __________________________________
ALL THREE CRITERIA of
__________________________________
EMR Utilization
B. Total Number of public __________________________________
X 100 =
primary care facilities (e.g.
RHU, HC) within the LGU

No
Data

Name of Facility Category Utilizes EMR for

(HC/RHU/BHS) digitalized service
delivery (Y/N)

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Assigned Date:
DOH Rep/IPHO
Page 1 of 3
 Reporting Year: 2023

* Put N/A if not applicable

* All BHS shall be accounted for in the above table but will not be included
in the computation. This information will be used for program/office
planning

Remarks (Write a short explanation for items answered “No”. Record

any implementation issues encountered):
__________________________________________________
__________________________________________________
__________________________________________________

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Assigned Date: Reporting Year: 2023
DOH Rep/IPHO
Page 2 of 3
 Part I. To be accomplished by the LGUs

LGU Name: _____________________ Date Accomplished: ______________

This is to certify that the data provided in the LGU Health Scorecard Data Capture Form are final and
correct to the best of our knowledge. We understand that the data we provided in the LGU Health Scorecard Data
Capture Form will be the basis in producing the LGU Health Report Card and performance results of Seal of Good
Local Governance – Health Compliance and Responsiveness Area.

SIGNED:

(Note: Affix your signature above printed name. Indicate your office &position opposite your name.)

LGU HSC Coordinator/Point Person

(Signature over Printed Name)

Local Health Officer/Officer-In-Charge

(Signature over Printed Name)

NOTED BY:

Local Chief Executive

(Signature over Printed Name)

Part II. To be accomplished by the DOH

This is to certify that the undersigned have reviewed the data provided in this LGU Health Scorecard Data
Capture Form.

Remarks: ___________________________________________________________________________
___________________________________________________________________________

VALIDATED BY:

(Note: Affix your signature above printed name)

Assigned DOH Representative/IPHO Chief

Technical
(Signature over Printed Name)

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Assigned Date: Reporting Year: 2023
DOH Rep/IPHO
Page 3 of 3