MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THIS PRESENTS:

____

This Memorandum in the

of Agreement made and byandbetween:

into this

The LOCAL GOVERNMENT OF THE CITY OF BACO R, a local government unit of the Philippines with office ad ress
at Evangelista St.

represented

herein

Bacoor, C vite by its City Mayor, Hon. STRI B.

1

Brgy.

Tabing

Dagat,

REVILLA, Ph.D.,

acting pursuant to Sangguniang layan Resolution No. 2013-12, dated January 7,2013, herei lafter' referred to as "CITY";' I and

ST. DOMINIC MEDICAL CENTER, INC., a corporation \dUlY

organized and existing under the laws of the Republic f the Philippines, with principal office address at St. Do inic Complex, Aguinaldo Highway, Talaba, Bacoor, Cavite, hi rein represented by its President Dr. GREGORIO ANDAMAN JR. and its Hospital Director, Dr. OSCAR D. TINIO, herei lafter called "SDMC."
WITNESSETH that: WHEREAS, numerous indigent resident patients of t e City of Bacoor requested the CITY for assistance on thei medical problems/ conditions; WHEREAS, the CITY, in its desire to extend freemedi services to the marginalized and underprivileged residents, as well a to public school teachers, non-teaching personnel and for its Bacoor G vernment employees, need to have hospital facilities to fulfill the task; I
1 1

WHEREAS, the HOSPITAL, possessing the facilities eeded by indigent patients requesting for medical assistance from the \CITY,has manifested its willingness to serve as retainer hospital to rend r medical services and confinement for patients referred by the CITY;
I I

NOW THEREFORE, for and in consideration' of the I foregoing premises, and the terms and considerations hereunder enum rated, the Parties to this Agreement hereby agree as follows: \

'
:

1.

The HOSPITALshall admit, provide and administer the Inecessary medical attention and services to all individuals referr d to it by the CITYas service patients through the Office of the M or under the City of Bacoor Hospitalization Program ("CBH). It is . understood, however, that the HOSPITAL shall rend r service mainly to tertiqry' c~ses and reserves the right 0 refuse en tertaining primary cast=;,s.The HOSPITAL shall not de and from the said patients any deposit or up-front payment as a Icondition for their admission, treatment or discharge if they prese t a valid Guaranty Letter (GL) from the CITY, but said amoun I shall be incorporated in the final hospital bill;
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2.

The HOSPITAL, in cases of emergency, shall ad !inister the necessary medical attention. The Emergency oom and professional fees shall however, be. paid by the patient I Provided, that if the patient is admitted to the HOSPITAL,then such room and professional fees shall be assumed and charged t CBHP and not by the patient If the patient is to be admitted, he/ I he may be . admitted upon presentation of the "Guaranty Lette I ("GL"). If admitted, a GL must be presented within 24 hours afte I admission or on the first working day if the day of emergenc falls on a Saturday, Sunday or official holiday . .The GL shall. bear the signature of the Mayor. In th preceding instances, the GL bearing the signature of the May Ir, shall be surrendered to the BillingSection of the HOSPITAL at I later date. Sample copies of the GL are hereto attached as Anne !es "A" and "B", respectively; If no GL is presented, the HOSPITALshall not consider the patient . to be covered by the CBHP, and shall be discharged ace rdingly;

3.

4.

The HOSPITALshall make available to the CITY, at al times and for the duration of this Agreement, its facilities for con inement of patients, at any time, in the department where the p I ients shall be properly treated. The CITYin-patient accommodatil n shall be strictly limited to Service Ward facilities. Provided, th It the CITY may also send to the HOSPITALits service patients for I ut-patient accommodation and the CITYshall be billed accordingl pursuant to the HOSPITAL'spertinent policies and procedures; I The professional services of a specified list of c Insultants, specialists, resident physicians, nurses and other perso' nel of the HOSPITAL, including medicines, laboratory examin tions and other diagnostic procedures shall be' made available to the CITY's service patients' (hereto attached as Annex "C']; The HOSPITAL shall give the CITY the right to vi it patientmembers and monitor their health conditions subject t pertinent regulations of the HOSPITAL.The CITY shall coordina Ie with the Office of the Deputy Director for Health Operations, subject to existing laws, rules and regulations on disposition of r cords. All expenses for accessing such records shall be for the s e account of the CITY;
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5.

6.

7.

The HOSPITALshall conduct an initial evaluation on t e patientmember's medical condition for the purpose of esti ating the possible medical expenses that will be incurred. If ithe initial estimate be more than the amount guaranteed in t e GL, the HOSPITAL shall immediately inform the CITY of suer possible discrepancy. The excess shall be charged to the acco I nt of the patient-member who is personally liable therefore. he CITY, however, shall render assistance to the HOSPITAL for th Icollection of unpaid hospital bill of the patient; The HOSPITALshall deduct, when applicable, Medicare Imployee's Compensation and other government-mandated medic I benefits from the hospital bills of a patient-member.

8.

It shall be solely responsible for ensuring that the pplication forms and supporting documents for the availmen of these benefits are duly accomplished and filed before a patiel t-member is discharged from the HOSPIT AL; 9. The HOSPITAL shall remit to the CITY any compensa paid or reimbursed by Philhealth in excess of the amou by the HOSPITALfrom the account of the patient withi days from receipt of Philhealth's payment. Corre should the Philhealth remittance be less than t deducted by the HOSPITAL,the discrepancy shall be the account of the CITY; The HOSPITALshall, free of charge, conduct an annu dental and minor surgical mission at an area designat the City;

r deducted

Ie charges thirty (30) pondingly, amount harged to

10.

medical, upon by

11.

The HOSPITAL shall, free of charge and after medical check-up, issue a medical certificate to all beneficiaries of the I onditional . cash transfer program (and/or 4Ps) of the City Dep tment of Social Welfare within the HOSPITAL'sterritorialjurisdict on;

12.

The HOSPITAL likewise commits to participate in t eSpecial Bacoor Resident (SBR) Card Program of the City and a [ide by the rules and regulations to be issued by the City Mayor. n relation thereto; For and in consideration of the foregoing terms and onditions, and for the services to be rendered by the HOSPITAL, the CITY shall allocate the amount of TWO MILLIO PESOS (P2,OOO,OOO.OO), herein cited as the FUND, for the dura of this Agreement, which amount shall be used the Local Gov rnment of Bacoor in settling bills issued to it by the HOSPITAL, ubject to approval of proper government offices and in accord! ce with existin!? government accounting and auditing r lIes and regulations. The amount of TWO HUNDRED FIFTY T 'OUSAND PESOS (P250,000.00) shall be deposited to the HOSPIT L as the bond of the CITYto secure treatment of CBHP eligible pa ients and to act as guaranty for the payment of all hospital bills on lime;

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ton

14.

For recording regular auditing and monitoring purposes, . monthly statement of actual HOSPITALcharges for CBHP patient I shall be prepared by the HOSPITAL, a copy of which is to be reql ested by the CITY for its review /perusal in accordance with the 'rocedure of Processing of Hospital Bills (Annex "D" hereof). The : ITY may countercheck for erroneous billings or entries to the HO: PITAL,if any, and shall inform the HOSPITALof such error with fifteen (15) days from receipt of the billings in question;

15.
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It is agreed upon by the parties that the City shall not be liable for any damages and/ or liability caused by the negligence an I / or fault of the Hospital, or any of its staff and/ or employee.

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16.

DISPUTE RESOLUTION All disputes controversies or claims arising out. of or rel ting to this Agreement, or about its breach, termination or invalid ty shall be settled through negotiation and/or mediation within six1y (60) days from receipt of a notice by the other party from the part I injured. All such conflicts which cannot be decided by negotia ion and/ or mediation shall be decided through P.D. 242 (pres: ribing the Procedures for Administrative Settlement or Adju ication of Disputes, Claims and Controversies between r among Government Offices and instrumentalities, including G vernmentOwned and Controlled Corporations and other Purpose .

17.

This Agreement shall be valid from January 1, 2013 t December 31,2013, and may be terminated by either party in th I event that any provision hereof is violated, by giving a 30-day wr tten notice to the other, without prejudice to any legal rights 0 the party terminated. The term of this Agreement shall be a ~omatically renewed for a period of one (1) year unless either party give notice of intention not to renew this Agreement . .Any amendment to this Agreement shall take effect on y after 'the written consent of both parties, which shall be embodi in a duly executed Supplement Agreement.

18.

IN WITNESS WHEREOF. the parties hereto have set thei hands on the date and at the place first above written.

THE LOCAL GOVERNMENT OF THE CITY OF BACOOR

ST. DOMINIC MEDICAL C By: 'A..M[.Mf0J~'. M.D.

BY:~
STRIKE B. REVILLA, p~

Mayor

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.Signed in the Presence

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~ ~RRAB~A City Legal Officer

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OSCAR D. TINIO, M.D.
Director

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Republic of the Philippines) ) S.S. ACKNOWLEDGMENT BEFORE ME, a Notary Public for FEB 2 2 2013, person y appeared, the following persons, presenting to me their respective Competen Evidence of Identity, as indicated below: Name Competent Evidence of Identity Date of Issue Place of Issue

Dr. Gregorio Andaman, Jr. Dr. Oscar D. Tinio, M.D. Mayor Strike B. Revilla, Ph.D.

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known to me and to me known to be the same persons who foregoing instrument denominated as Memorandum of Agreement four (4) pages, including this page, having acknowledged before their own free and voluntary act and deed, and that of the respectively represent in this instance.
TO THE TRUTH OF THE FOREGOING, witness now my h

pcecuted the ,onsisting of I e that it is entity they

d and seal

on the date and at the place indicated.

Doc.No.~ PageNo.~ BookNo.~ Series of 2013.

ATTV.iLME T RA8UYA APPUCATlONNO. 011-21

NOlMYUNTll D~GE I ER31, 20B
ROUNO 42 58

ISP LifETIME NQ ~567 P1R NO. 2'117641; JAM. 22011 CAVITe