Federal Teaching Hospital, Lokoja

Monthly Reporting Form

NHIA service delivery, CEmONC enrolment, clinical activity and quality improvement

Confidential
1

Update on Assignments from Previous Meeting

Follow-up on Previous Meeting Action Items

Track the status of assignments from the previous meeting and document actions taken.

Assignment Action Taken Status

Additional Notes

2

Key Performance Indicators

Headline figures for rapid review by departmental and hospital management
Total patients seen
NHIA patients seen
Non-NHIA patients seen
CEmONC patients enrolled
Medical reports issued
NHIA enrollee population
NHIA claims submitted
Clinical procedures

Major achievements / highlights this month

3

NHIA Service Delivery

Monthly NHIA workload and enrollee activity handled by Family Medicine
NHIA Indicator Total
Total NHIA enrollees registered / attached to the facility
NHIA enrollees seen in Family Medicine
New NHIA patients
NHIA follow-up patients
Adult NHIA patients
Paediatric NHIA patients
Male NHIA patients
Female NHIA patients
4

NHIA Enrollee Trend

Record the total NHIA enrollee population for each month to support trend analysis
Month Total NHIA Enrollees
January
February
March
April
May
June
July
August
September
October
November
December
5

NHIA Claims Performance

Financial indicator specifically retained for Family Medicine/NHIA reporting
Indicator Amount (₦)
Total value of NHIA claims submitted
6

HMO / NHIA Operational Monitoring

Focused operational information without the excluded authorisation and outstanding-payment fields
Indicator Total
Number of active HMOs utilised during the month
Number of HMOs with unresolved claims/issues

Major HMO/NHIA operational issues and action taken

8

Medical Reports & Documentation

Administrative and clinical documentation workload
Indicator Total
Medical reports requested
Medical reports issued
Reports pending
Medical certificates issued
Sick certificates issued
Insurance / HMO reports
Occupational / fitness reports
Other reports

Remarks

9

Quality Improvement / Clinical Audit

Document improvement activities undertaken during the reporting month
Indicator Total
Audits conducted
QI projects active
QI actions completed

Audit / QI topic and key findings

Additional Notes

10

Milestone Achievements

Notable Accomplishments This Month

Record major milestones, service improvements and notable accomplishments reached during the reporting month.

10

Observations & Requests to Management

Escalations & Action Items

Priority Interventions Required In Order of Urgency

# Intervention
1
2
3

General Remarks and Recommendations

Comments

Additional Notes

Document Ref. FTHL/FMD/2026/1102 · Complete all applicable sections before submission