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Application Form

DOH application form for HIV testing laboratory

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
Department of Health

HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
ANNEX H-3a

A.O. No. 2016CHECKLIST FOR REVIEW OF FLOOR PLANS
RESIDENTTAL DRUG ABUSE TREATMENT AND REHABTLTTATTON CENTER (TNPATIENT)

Name of Health Facility:
Address:
Date:

Review:

1"t

2nd

3rd

1. PHYSICAL PLANT

1.1 Administrative Office
1.2 Client Reception and Waiting Area
_1.3 Counseling and Testing Room
_1.4 Emergency Clinic
_1.5 Living quarters (at least 7.43m' per bed)
_1.6 Toilet and bath
.7 Staff toilet
1.8 Indoor Activity Area
1.9 Outdoor Activity Area
1

1.10

_1.11

Dining Area

Kitchen

2. PLANNING AND DESIGN
Floor plans properly identified and completely labeled
_21
2.2 Conforms to applicable codes as part of normal professional service:
Exits restricted to the following types: door leading directly outside the
_22J
building, interior stair, ramp, and exterior stair
2.2.2 Minimum of two (2) exits, remote from each other, for each floor of the
building
2.2.3 Exits terminate directly at an open space to the outside of the building

2.3

Meets prescribed functional programs:
Main entrance of the facility directly accessible from public road
_2.31
_23.2 Assignment of function areas follows logical flow
_2.3.2.1 Client reception area located near entrance and
immediately accessible to client
Examination and treatment room near reception area
_2.3.22
2.3.2.3 Counseling and testing room near the reception area
2.3.2.4 Administrative office near the entrance
2.3.3 Separate toilets/baths and living quarters for male and female residents
2.3.4 Ratio of toilet and bath to residents (1:8)

GOMMENTS:

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Republic of the Philippines
Department of Health

HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

Name of Health Facility:

Address:
COMMENTS:

HEALTH FACTLTTTES EVALUATTON AND REVTEW COMMTTTEE (HFERC)

I lApproved

[

]Disapproved

Chairperson, HFERC

Vice-Chairperson,

Member

H

FERC

Member

Member

Member

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