CALOOCAN CITY NORTH MEDICAL CENTER

MONITORING & EVALUATION

SDN PERFORMANCE REPORT

MONTH- YEAR
 SDN ACTIVITIES
• Orientation of Hospital Staff on SDN
HOSPITAL UNIT CATEGORY OF NO. OF STAFF DATE
STAFF

ER Consultant 2 March 23,2018

DR Nurse
OPD
Doctor 2
 SDN DATA COVERAGE
INCOMING REFERRALS (EMERGENCY ROOM)
MONTH HEALTH GOVT’T PRIVTE GOV’T PRIVATE UNKNOWN TOTAL
CENTERS BIRTHING BIRTHING HOSPITAL HOSPITAL
HOME HOME

INCOMING REFERRALS ( OUT PATIENT DEPARTMENT)

 SDN DATA COVERAGE
(INCOMING REFERRALS)
SUMMARY OF CLIENTS RECEIVED
MONTH ER OPD TOTAL
 SDN DATA COVERAGE
INCOMING REFERRALS
NAME OF REFERRING TOTAL NUMBER PERCENT
HEALTH FACILITY OF INCOMING
REFERRALS

TOTAL
 SDN DATA COVERAGE
QUALITY OF INCOMING REFERRALS:

REASONS FOR REFERRALS NUMBER

RECEIVED

total
 SDN DATA COVERAGE
INCOMING REFERRALS
CLASSIFICATION OF REFERRALS NUMBER PERCENT (%)
RECEIVED

TOTAL
 SDN DATA COVERAGE
INCOMING REFERRALS
TYPES OF UNCLASSIFIED REFERRALS NUMBER PERCENT
RECEIVED (%)
 SDN DATA COVERAGE
INCOMING REFERRALS

TOTAL NUMBER PERCENT TOTAL NUMBER PERCENT

OF ACCEPTED OF NON-
REFERRALS ACCEPTED
REFERRALS
SDN DATA COVERAGE
REASONS FOR NON-ACCEPTANCE NUMBERS
 SDN DATA COVERAGE
ISSUES AND GAPS (Referral Form received)

Incomplete Patient’s Information NUMBERS

Age
Address 0
Education
Civil Status
Religion
Occupation
Membership
 SDN DATA COVERAGE
ISSUES AND GAPS (Referral Form received)

INCOMPLETE PATIENTS’ ASSESSMENT NUMBERS

History
Chief Complaint
LMP, AOG, EDC, OB SCORE
VITAL SIGNS (BP, HR, TEMP. WT.) BLOOD TYPING
PPE
FH, FHB
IMPRESSION
 SDN DATA COVERAGE
ISSUES AND GAPS (Referral Form received)

REFERRING FACILITY AND PATIENT’S CONSENT NUMBERS

REASON FOR REFERRAL
REFERRING PERSONNEL AND DESIGNATION
FACILITY NAME AND CONTACT NUMBER
PATIENT NAME, SIGNATURE AND CONTACT
NUMBER
 SDN DATA COVERAGE
ISSUES AND GAPS (Outgoing Referral)

REASONS FOR REFERRAL NUMBERS

1. FP services
2. For consultation
3. Diagnostic test
4. Transfer of service
 SDN DATA COVERAGE
ISSUES AND GAPS (Outgoing Referral)

RETURN SLIP
TOTAL NUMBER OF TOTAL NUMBER OF TOTAL NUMBER OF
RETURN SLIP RETURN SLIP RECEIVED RETURN SLIP WITH
GIVEN/ISSUED WITH COMPLETE INCOMPLETE
INFORMATION INFORMATION

0 0
 SDN DATA COVERAGE
MATERNAL MORTALITY

RESIDENCE OF CALOOCAN NON-RESIDENCE OF

CALOOCAN
0 0

NEONATAL MORTALITY
RESIDENCE OF CALOOCAN NON-RESIDENCE OF
CALOOCAN
0 0
 SDN DATA COVERAGE
• Other issues:
1. Incoming referral forms misplaced by staff.
2. Incomplete SDN referral slip.
3. No communication from referring health
facility.
4. No contact number of referred health facility.
 SDN COVERAGE
• GAINS:
1. Helps in improving maternal and neonatal
health outcomes.
2. Patient was able to be treated in the
appropriate health facility.
 SDN COVERAGE
• RECOMMENDATIONS:
1. Availability of telephone directory/trunklines
of each health facility and point person.
 FP JANUARY 2018

FP Method Current New Drop Total

Users Acceptors out
POP
COC
IIUD
PPIUD
POI
LAM
CONDOM
 FP FEBRUARY 2018

FP Method Current New Drop Total

Users Acceptors out
POP
COC
IIUD
PPIUD
POI
LAM
CONDOM
 FP MARCH 2018

FP Method Current New Drop Total

Users Acceptors out
POP
COC
IIUD
PPIUD
POI
LAM
CONDOM