1.1 Classification
Service Capability: General
[ ] Level 1 Hospital
[ ] Level 2 Hospital
[ ] Level 3 Hospital (non-teaching and non-training)
[ ] Level 4 Hospital (teaching and training)
1.2 Bed Capacity/Occupancy:
Authorized bed capacity ______ beds
Actual/Implementing beds ______ beds
Bed occupancy rate (BOR) for the month based on authorized beds ______ %
Total inpatient service days for the period * /{(Total no. of authorized beds) x (Total days in the period)} x 100
*This BOR is for a certain period - usually a calendar year but one can calculate for a month to compare month-to-month variations, for example.
1.3 Bed Count:
Number of beds per service based on actual bed capacity
No. of Beds
No. of beds per classification:
Pay ______________
Service ______________
No. of beds per service:
Medicine ______________
Obstetrics ______________
Gynecology ______________
Pediatrics ______________
Surgery ______________
Pedia ______________
Adult ______________
Others: Specify _________________
TOTAL ______________
(Note: In the Philippine context, "pay beds" are usually found in single or private and semi-private rooms. "Service beds" usually refer to ward beds and assigned to different specialties. As this is a sample M&E form only, there can be other classifications that are not seen here. The number of beds per service should be the total of all the beds in these services.)