Hospital Service Summary Report
Government of Nepal
Ministry of Health and Population
Department Of Health Services
Public Hospital Monthly Reporting Form
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Fiscal Year 20...../20..... T0 HF Code
Reference No: Subject: Submission of Monthly Report on Hospital Services : M...../Y 20.....
Hospital Services Emergency Services
Age Group New Client Serviced Total Clients Served Total Clients Served
Female Male Female Male Female Male
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Free Service Received
by Impoverished Citizen
Female Male
1 2 3
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ORC Clinics / FCHV Planned / Total No. Conducted / Report Received. No of Clients Served.
Outreach Clinic - - -
Immunization Clinic - - -
Immunization Session - - {{immunizationServices[0]?.TotalVaccinationClientServed}}
Hygiene Promotion Session - - -
FCHV - - -
Referrals Referral In Referred Out
Outpatient Inpatient Emergency
Female - {{outpatientReferredOut.OpReferred_FemaleCount}} {{HospitalServiceSummaryReport?.InpatientReferredOut[0]?.IpRO_FemaleCount}} -
Male - {{outpatientReferredOut.OpReferred_MaleCount}} {{HospitalServiceSummaryReport?.InpatientReferredOut[0]?.IpRO_MaleCount}} -
Available Services (Circle the appropriate code) Services Available Services (Circle the appropriate code) Services
Yes No Yes No
Birthing Center 1 2 DOTS Site 1 2
BEONC Site 1 2 Microscopy Site 1 2
CEONC Site 1 2 Laboratory Service 1 2
Safe Aboration Service (SAS) Site 1 2 HTC Site 1 2
IUCD Service Site 1 2 PMTCT Site 1 2
Implant Service Site 1 2 CB-PMTCT Site 1 2
Adolescent Friendly Service Site 1 2 ART Site 1 2
OTC Site 1 2 Other (Specify)... 1 2
Dispatched Date :                /          /           207...
Received Date :               /           /           207...
Sanctioned Bed Operational Inpatient Bed Emergency Bed
Total Patients Admitted {{totalPatientAdmitted != null && totalPatientAdmitted.length>0 && !!totalPatientAdmitted[0].TotalPatientsAdmitted ? totalPatientAdmitted[0].TotalPatientsAdmitted : 0}}
Total Inpatient Service Days {{totalInpatientDays != null && totalInpatientDays.length>0 && !!totalInpatientDays[0].TotalInpatientDays ? totalInpatientDays[0].TotalInpatientDays : 0}}
Diagnostic / Other Services Unit No.
{{d.ReportingItemName}} {{d.Unit}} {{d.TotalCount}}
Total Laboratory Service Provided Person {{TotlLabServiceProvidedPersonCount}}
Other Service Provided (If any) Person -
Minimun Service Standard (MSS) Date Implementation Score (%)
1. First 2. Second
Prepared By:

Signature:

Name of Medical Recorder:

Approved By:

Signature:

Name of Hospital Superintendent/Director: