Office / Division:	QCHD – Epidemiology and Surveillance Division
Classification:	Simple
Type of Transaction:	G2C – Government to Citizen
Who may avail:	ALL

Checklist of Requirements

Requirements	Where to Secure
(soft copy/Hardcopy) Signed Request Letter Address to: Dra. Ramona Asuncion DG Abarquez OIC - Acting City Health Officer III Request Form	Physical Form – available at the receiving area of the City Health Department Website – requesting agencies can download the surveillance request form at: https://qcesu.quezoncity.gov.ph/forms Link and QR Code – are provided in this Citizen’s Charter and at the receiving areas of the City Health Department

Client Steps and Agency Action

Client Steps	Agency Action	Fees to be Paid	Processing Time	Person Responsible
1. Fill out Specimen Collection request form http://tinyurl.com/health-lecture-resource	1. Provide QR/Physical Form/Link	None	2 minutes	Data Validator
2. Submit Provision of Health Lecture/Resource Speaker on Disease Surveillance and Prevention program request form via email/ link	2. Acknowledge Request Provide Request Reference Number	None	2 minutes	Data Validator
3. Wait for the action on the request.	3. Validate requested data 3.1 Purpose of Data Request 3.2 Check Specimen Kit Availability 3.3 Obtain Approval	None	3 to 5 days	Data Validator
4. Receive Response on the requested data and fill out client satisfaction survey. http://tinyurl.com/satisfaction-survey-central or	4. Provide requested kit and/or feedback.	None	2 minutes	Logistics
	TOTAL	NONE	3 to 5 days