Purchase of printing of Hospital Forms - PGH(1887) Request for Quotation (RFQ)   Reference Number 11313467   Procuring Entity MUNICIPALITY OF POLOMOLOK, SOUTH COTABATO   Title Purchase of printing of Hospital Forms - PGH(1887)   Area of Delivery South Cotabato   Printable Version Solicitation Number: NP-01-1887 Trade Agreement: Implementing Rules and Regulations Procurement Mode: Negotiated Procurement - Small Value Procurement (Sec. 53.9) Classification: Goods Category: Office Supplies and Devices Approved Budget for the Contract: PHP 51,032.00 Delivery Period: 30 Day/s Client Agency: Contact Person: Mary Ann Pama Almio Computer Maintenance Technologist I Poblacion, Polomolok, South Cotabato Polomolok South Cotabato Philippines 9504 63-83-2253121 maryalmio28@gmail.com Status Active Associated Components Order Bid Supplements 0 Document Request List 0 Date Published 03/10/2024 Last Updated / Time 03/10/2024 12:00 AM Closing Date / Time 07/10/2024 2:00 PM Description Purchase of printing of Hospital Forms - PGH(1887) ITEM NO. QTY UNIT DESCRIPTION OF ARTICLES OF MATERIALS 1 1 ream Admission Slip (For ER use only) 2 2 ream ADMISSION WAIVER 3 1 ream ANATOMICAL DIAGRAM HEAD 4 1 ream ANATOMICAL DIAGRAM WHOLE BODY 5 3 ream ATTENDING PHYSICIAN'S REPORT 6 4 ream BALLARD SCORE SHEET 7 1 ream BIOPSY RQST -SURGICAL PATHOLOGY REQUEST FORM 8 1 ream BLOOD REQUEST,REQUEST INFORMATION FORMS 9 1 ream BLOOD TRANSFUSION FORM 10 1 ream BLOOD TRANSPORT FORM 11 4 ream BREASTFEEDING IMMUNIZATION NEWBORN SCREENING 12 1 ream CONSENT AND AUTHORIZATION FOR BILATERAL TUBAL LIGATION 13 3 ream CONSENT FOR ADMISSION-CONFINEMENT 14 1 ream CONSENT FOR BLOOD EXTRACTION 15 1 ream CONSENT FOR BLOOD TRANSFUSION 16 1 ream CONSENT FOR CHANGES ON THE MEDICAL RECORDS 17 4 ream CONSENT FOR DISCHARGE 18 1 ream CONSENT FOR out-on-pass PROCEDURE 19 3 ream CONSENT FOR PATIENT PERSONAL INFORMATION 20 3 ream CONSENT FOR PROCEDURE 21 1 ream CONSENT FOR TRANSFER 22 4 ream CONSENT FOR TREATMENT 23 2 ream CONSENT FORM FOR MINOR SURGERY 24 1 ream CONSENT FOR THE RELEASE OF CADAVER25 1 ream CONSENT FOR THE RELEASE OF BODY TISSUE/ ORGAN 26 2 ream DAILY FLOOR CENSUS 27 1 ream DISCHARGE AGAINST MEDICAL ADVICE (DAMA) 28 3 ream DELIVERY ROOM RECORD 29 1 ream DELIVERY INFORMATION SHEET 30 1 ream ECG FORM 31 1 ream EMERGENCY FLOW SHEET 32 1 ream ENDORSEMENT SHEET (NS) 33 1 ream ER CHART FOR DOA AND ER DEATH 34 1 ream FAMILY PLANNING REFERRAL FORM 35 1 ream FETAL DEATH INFORMATION SHEET(0-7) 36 1 ream DEATH INFORMATION SHEET 37 7 ream GRAPHIC SHEET 38 1 ream IMMUNIZATION RECORD 39 3 ream INFORMATION REGISTRATION & PRIVACY CONSENT 40 3 ream INSULIN SHEET 41 3 ream INTAKE AND OUTPUT EVERY HOUR 42 3 ream INTAKE AND OUTPUT EVERY SHIFT 43 1 ream INTUBATION RESUSCITATION WAIVER 44 7 ream IV FLOW SHEET 45 5 ream KARDEX 46 2 ream LABOR RECORD 47 2 ream LABORATORY REQUEST 48 2 ream LINEN CHECKLIST 49 1 ream MEDICAL EMERGENCY NURSE’S NOTES 50 7 ream MEDICATION SHEET 51 1 ream MENTAL STATUS EXAMINATION FORM 52 2 ream NEBULIZATION SHEET 53 2 ream NEUROLOGIC EXAMINATION FORM 54 1 ream NEUROVITAL SIGN SHEET 55 2 ream NEWBORN DISCHARGE CHECKLIST 56 7 ream NURSES NOTES FDAR 57 2 ream OBSTETRICAL DATA SHEET 58 3 ream OPD SOAP FORM 59 2 ream OPERATING RECORDS MINOR 60 2 ream OUT PATIENT SURGICAL PROCEDURE FORM 61 2 ream PATIENT CHART COMPLETENESS CHECKLIST B 62 3 ream PATIENT EVALUATION-IN 63 3 ream PATIENT EVALUATION-out 64 2 ream PATIENT INFORMATION AND ASSESSMENT FORM 65 2 ream PATIENT'S CONSENT FOR REFERRAL 66 3 ream PATIENT'S RIGHT RIGHTS AND RESPONSIBILITIES 67 3 ream PEAK EXPIRATORY FLOW RATE 68 1 ream PHIC REFERRAL FORM 69 8 ream PHYSICIAN ORDER SHEET 70 3 ream PHYSICIAN'S RECORD OF NEWBORN INFANT 71 1 ream PRE OPERATIVE CHECKLIST 72 1 ream PRE OPERATIVE MEDICAL EVALUATION FORM 73 1 ream PREANESTHETIC EVALUATION AND DISPOSITION SHEET 74 1 ream PRESCRIPTION SLIP WITH PTR 75 2 ream RADIOLOGY REQUEST 76 1 ream REFERRAL FORM 77 2 ream REPORT OF OPERATION 78 1 ream REQUEST FOR A COPY OF MEDICAL RECORDS 79 2 ream SERVICE AVAILABILITY WAIVER 80 1 ream SURGICAL CHECKLIST 81 7 ream VITAL SIGN MONITORING RECORD 82 1 ream WAIVER FOR NO RESUSCITATION 83 1 ream WAIVER FOR REFUSE ADMISSION 84 1 ream WAIVER FOR REFUSE TREATMENT DIAGNOSTIC 85 1 ream ANESTHESIA RECORD 86 1 ream ROUTE FREQUENCY SLIP 87 1 ream PHILHEALTH PORTAL INFO SHEET 88 2 ream ANESTHESIA RECORD 89 1 ream ROUTE FREQUENCY SLIP 90 1 ream REFERRAL SLIP TO SOCIAL SERVICE 91 1 ream MEDICAL SOCIAL WORK (CASE NOTES) 92 1 ream CERTIFICATE OF ELIGIBILITY 93 1 ream UNIFIED INTAKE SHEET Line Items Item No. Product/Service Name Description Quantity UOM Budget (PHP) 1 FORMS Purchase of printing of Hospital Forms - PGH(1887) 1 Lot 51,032.00 Created by Rommel Oroceo Subaldo Date Created 02/10/2024 The PhilGEPS team is not responsible for any typographical errors or misinformation presented in the system. PhilGEPS only displays information provided for by its clients, and any queries regarding the postings should be directed to the contact person/s of the concerned party.       MUNICIPALITY OF POLOMOLOK, SOUTH COTABATO