PCPAccFrm E-4A1F1 Rev2014

Hospital:The Premier Medical General Hospital

Admissions:

Ward Census
Enter the Month

Case-load (case census per year) and results of care and Year
Month/Year: December 2014
739

Total IM Admissions:

CARDIOLOGY
1
2
3
4
5
6

ICD 10

Hypertension

I10

Acute Coronary Syndrome

I20

Cardiovascular Disease

I25

Hypertensive CV Disease (Primary & Secondary)

I11

Hypertensive Emergency

I10

Cardiac Dysrhythmia

I49.9

TOTAL

INFECTIOUS DISEASES

Enter Total IM
Admisssions (Patient
person count) for
the Month

ICD 10

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

85
26
57
43
5
7
223

11.50%
3.52%
7.71%
5.82%
0.68%
0.95%
30.18%

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

9.07%
2.44%
0.27%

1
2
3

SVI

B08

67
18
2

Rabies

A82

0.41%

A90

0.81%
0.00%
12.99%

5
6

Pneumonias (Community & Hospital Acquired)

J15

Sepsis & Septic Shock

A41

Dengue Fever

TOTAL

We attest to the truthfulness of the above documentation:

96

# of
Mortality

2
15

17

# of
Mortality

15
8

% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
7.69%
26.32%
0.00%
0.00%
0.00%
7.62%
% of
Mortality
(# of
deaths/ #
of Cases)

22.39%
44.44%
0.00%
0.00%

1
24

16.67%
#DIV/0!
25.00%

Chairman, Dept. of MedicinePage 1 of 30

PCPAccFrm E-4A1F1 Rev2014

PULMONARY MEDICINE

ICD 10

Pleural Effusion
1
2 Pulmonary Congestion
3 Parapneumonic Pleural Effusion
4 Chronic Obstructive Pulmonary Disease
5 Empyema Thoracis
6
7 Acute Respiratory Distress Syndrome

J91
J81

J91.8
J44.1
J86

J80
TOTAL

GASTROENTEROLOGY

K52
V12
K74
K22
M34

K64
K59
K81
TOTAL

We attest to the truthfulness of the above documentation:

35
4
2
46
2
2
91

ICD 10

Gastroenteritis
1
Peptic Ulcer Disease
2
Liver Cirrhosis
3
Upper GI Bleeding
4
Chemical Ingestion
5
Hemorrhoids
6
7 Chronic Constipation
8
9 Acute Cholecystitis
14

# of
Cases

# of
Cases

33
4
15
3
4
8
2
2
71

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

# of
Mortality

4.74%
0.54%
0.27%
6.22%
0.27%
0.27%
0.00%
12.31%

16

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

# of
Mortality

4.47%
0.54%
2.03%
0.41%
0.54%
1.08%
0.27%
0.27%
0.00%
9.61%

2
1

1
20

% of
Mortality
(# of
deaths/ #
of Cases)

5.71%
25.00%
0.00%
34.78%
0.00%
50.00%
#DIV/0!
21.98%
% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
#REF!
#DIV/0!
0.00%

Chairman, Dept. of MedicinePage 2 of 30

PCPAccFrm E-4A1F1 Rev2014

NEPHROLOGY

ICD 10

Acute Pyelonephritis
1
2 Pregnancy Uterine
3 Complicated Urinary Tract Infection
4 Missed Abortion
5

N10
O26
N39
O02.1

TOTAL

ENDOCRINOLOGY
1
2
3
4

Electrolyte Imbalance

P74

Hyperthyroidism

P72

Malnutrition

E40

Diabetes Mellitus T2

V18

We attest to the truthfulness of the above documentation:

8
6
4
3
21

ICD 10

TOTAL

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

1.08%
0.81%
0.54%
0.41%
0.00%
2.84%

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

4
9
12
40
65

0.54%
1.22%
1.62%
5.41%
8.80%

# of
Mortality

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
0.00%
#DIV/0!
0.00%
% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
0.00%
0.00%

Chairman, Dept. of MedicinePage 3 of 30

PCPAccFrm E-4A1F1 Rev2014

HEMATOLOGY
1
2
3
4
5
6
7
8
9

ICD 10

Acute Lymphocytic Leukemia

C91

Aplastic Anemias

D61

Anemia of Chronic Disease

D63

Non Hodgkins Lymphoma

C85

Superior Vena Canal Obstruction

I87.1

Hypovolemic Shock

R57

Hemophilia

D66

Malignant Lymphoid Neoplasm

C10

Chronic Myelogenous Leukemia

C92

TOTAL

NEUROLOGY

ICD 10

Epilepsy
1
2 Seizure Disorder
3 Chronic Inflammatory Demyelnating Polyaduculoneuropathy
4 Brain Herniation
5 Alcohol Withdrawal Syndrome
6 Post Gliotic Seizure
14

TOTAL

We attest to the truthfulness of the above documentation:

G40
G40
G61.8

G93.5
F10
G40

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

1
11
5
5
2
5
3
2
6
40

0.14%
1.49%
0.68%
0.68%
0.27%
0.68%
0.41%
0.27%
0.81%
5.41%

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

5
10
2
8
10
8
43

0.68%
1.35%
0.27%
1.08%
1.35%
1.08%
0.00%
5.82%

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
0.00%
0.00%
20.00%
0.00%
0.00%
0.00%
2.50%

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%
12.50%
0.00%
0.00%
#DIV/0!
2.33%

Chairman, Dept. of MedicinePage 4 of 30

PCPAccFrm E-4A1F1 Rev2014

ONCOLOGY

ICD 10

Breast CA
1
Pancreatic
Cancer
2
3 Oral CA
4 High Grade Sarcoma

D05
C25
C06
C96.4

TOTAL

DERMATOLOGY

ICD 10

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

26
2
7
2
37

3.52%
0.27%
0.95%
0.27%
5.01%

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

# of
Mortality

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
50.00%
0.00%
0.00%
2.70%
% of
Mortality
(# of
deaths/ #
of Cases)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of MedicinePage 5 of 30

PCPAccFrm E-4A1F1 Rev2014

RHEUMATOLOGY

ICD 10

1 Gout

M10

TOTAL

ALLERGOLOGY & IMMUNOLOGY

1
2

ICD 10

Asthma in Exacerbation

J45

Snake Envenomation

T63

TOTAL

We attest to the truthfulness of the above documentation:

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

25
25

3.38%
3.38%

# of
Cases

% of Total
Admissions
(# of
cases/ Total
IM
admissions)

24
3
27

3.25%
0.41%
3.65%

# of
Mortality

# of
Mortality

% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
% of
Mortality
(# of
deaths/ #
of Cases)

0.00%
0.00%
0.00%

Chairman, Dept. of MedicinePage 6 of 30

PCPAccFrm E-4A1F1 Rev2014

Enter Name
of Hospital

Enter the place

of census i.e.
Ward, ICU, ER, or
OPD
Manually count the
disease entity from
your monthly census
and enter here.

Manually count the

number of death per
disease entity from
your monthly census
and enter here.

Yellow boxes
automatically
computed from data
entered in the
shaded boxes. DO
NOT WRITE
ANYTHING ON THE
YELLOW BOXES.

We attest to the truthfulness of the above documentation:

Chairman, Dept. of MedicinePage 7 of 30

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of MedicinePage 8 of 30

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of MedicinePage 9 of 30

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 10 of 30

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 11 of 30

PCPAccFrm E-4A1F1 Rev2014

We attest to the truthfulness of the above documentation:

Chairman, Dept. of Medicine

Page 12 of 30

PCPAccFrm E-4A1F1 Rev2014

The Premier Medical General Hospital

Hospital:

Admissions:

Ward Census
Enter the Month

Case-load (case census per year) and results of care and Year
Month/Year:

MAY 2012

Total IM Admissions:

CARDIOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

INFECTIOUS DISEASES
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
We attest to the truthfulness of the above documentation:

ICD 10

# of
Cases

Enter Total IM
Admisssions
(Patient person
count) for the
Month

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
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#DIV/0!
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#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
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#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 13 of 30

PCPAccFrm E-4A1F1 Rev2014

16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 14 of 30

PCPAccFrm E-4A1F1 Rev2014

PULMONARY MEDICINE

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

GASTROENTEROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 15 of 30

PCPAccFrm E-4A1F1 Rev2014

NEPHROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

ENDOCRINOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
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#DIV/0!
#DIV/0!
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#DIV/0!
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#DIV/0!

#DIV/0!
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#DIV/0!

#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 16 of 30

PCPAccFrm E-4A1F1 Rev2014

HEMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

NEUROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 17 of 30

PCPAccFrm E-4A1F1 Rev2014

ONCOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

DERMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 18 of 30

PCPAccFrm E-4A1F1 Rev2014

RHEUMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

ALLERGOLOGY & IMMUNOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 19 of 30

PCPAccFrm E-4A1F1 Rev2014

The Premier Medical General Hospital

Hospital:

Admissions:

Ward Census

Case-load (case census per year) and results of care

Month/Year:

JUNE 2012

Total IM Admissions:

CARDIOLOGY

ICD 10

# of
Cases

0
0

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

INFECTIOUS DISEASES
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
We attest to the truthfulness of the above documentation:

ICD 10

# of
Cases

Enter the Month

and Year
Enter Total IM
Admisssions
(Patient person
count) for the
Month

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

0
0

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 20 of 30

PCPAccFrm E-4A1F1 Rev2014

16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 21 of 30

PCPAccFrm E-4A1F1 Rev2014

PULMONARY MEDICINE

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

GASTROENTEROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 22 of 30

PCPAccFrm E-4A1F1 Rev2014

NEPHROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

ENDOCRINOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 23 of 30

PCPAccFrm E-4A1F1 Rev2014

HEMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

NEUROLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 24 of 30

PCPAccFrm E-4A1F1 Rev2014

ONCOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

DERMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

Chairman, Dept. of Medicine

Page 25 of 30

PCPAccFrm E-4A1F1 Rev2014

RHEUMATOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

ALLERGOLOGY & IMMUNOLOGY

ICD 10

# of
Cases

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL

We attest to the truthfulness of the above documentation:

% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

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% of Total
% of
Admissions
# of
Mortality
(# of
Mortalit
(# of
cases/ Total
y
deaths/ #
IM
of Cases)
admissions)

#DIV/0!
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Chairman, Dept. of Medicine

Page 26 of 30

PCPAccFrm E-4A1F2 Rev2014Philippine

College of Physicians
Ward Census

SUMMARY OF CENSUS

The Premier Medical General Hospital

HOSPITAL
Month/Year

December 2014

% of Total Admissions
(# of cases/total IM
# of Cases
Cases)

Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

Total IM Cases
Total IM Admissions

# of Mortality

% Mortality
(# of deaths/ #
of cases)

17
24
20
0
0
0
1
1
1
0
0
0

7.62%
25.00%
21.98%
0.00%
0.00%
0.00%
2.50%
2.33%
2.70%
#DIV/0!
0.00%
0.00%

223
96
91
71
21
65
40
43
37
0
25
27

30.18%
12.99%
12.31%
9.61%
2.84%
8.80%
5.41%
5.82%
5.01%
0.00%
3.38%
3.65%

739
739

Total Mortality
Total Mortality/Total Admissions

64
8.66%

Ward Census

SUMMARY OF CENSUS

The Premier Medical General Hospital

HOSPITAL
Month/Year

MAY 2012
Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

Total IM Cases
Total IM Admissions

% of Total Admissions
(# of cases/total IM
# of Cases
Cases)

# of Mortality

% Mortality
(# of deaths/ #
of cases)

0
0
0
0
0
0
0
0
0
0
0
0

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

0
0
0
0
0
0
0
0
0
0
0
0

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0
0

Total Mortality
Total Mortality/Total Admissions

0
#DIV/0!

PCPAccFrm E-4A1F2 Rev2014Philippine

College of Physicians
Ward Census

SUMMARY OF CENSUS

The Premier Medical General Hospital

HOSPITAL
Month/Year

JUNE 2012

% of Total Admissions
(# of cases/total IM
# of Cases
Cases)

Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

Total IM Cases
Total IM Admissions

Total IM Cases
Total IM Admissions

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

0
0

Total Mortality
Total Mortality/Total Admissions

0
#DIV/0!

Ward Census
The Premier Medical General Hospital

HOSPITAL

Cardiology
Infectious Diseases
Pulmonary Medicine
Gastroenterology
Nephrology
Endocrinology
Hematology
Neurology
Oncology
Dermatology
Rheumatology
Allergology & Immunology

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

SUMMARY OF CENSUS

Months/Year
December 2014
MAY 2012
JUNE 2012

# of Mortality

% Mortality
(# of deaths/ #
of cases)

# of Cases % of Total Admissions

(# of cases/total IM
Cases)

# of Mortality

% Mortality
(# of deaths/ #
of cases)

17
24
20
0
0
0
1
1
1
0
0
0

7.62%
25.00%
21.98%
0.00%
0.00%
0.00%
2.50%
2.33%
2.70%
#DIV/0!
0.00%
0.00%

223
96
91
71
21
65
40
43
37
0
25
27

30.18%
12.99%
12.31%
9.61%
2.84%
8.80%
5.41%
5.82%
5.01%
0.00%
3.38%
3.65%

739
739

Total Mortality
Total Mortality/Total Admissions

64
8.66%

PCPAccFrm E-4A1F2 Rev2014Philippine

College of Physicians

PCPAccFrm E-4A1F2 Rev2014Philippine

College of Physicians