Вы находитесь на странице: 1из 6

MEMORANDOM OF AGREEMENT

KNOW ALL MEN BY THIS PRESENTS

This MEMORANDOM OF AGREEMENT is entered into for the Philippine Health Insurance
Corporation(PhilHealth) Maternity Care Package by and between the:

CHARIS JOY R. DOONG RM, RN of legal age and single, herein known to as the SERVICE
PROVIDER of the party of the FIRST PART.

AND

JOEYLIN ABASOLO - PARCON, MD, DPPS, with home address at Kidapawan City, North
Cotabato, of legal age and married, herein after known as the PARTNER OBSTETRICIAN of the
party of the SECOND PARTY.

WITNESSETH

WHEREAS, to ensure that quality of care is provided to the patient, the SERVICE PROVIDER is
required to have A PARTNER OBSTETRICIAN for referral and further management of newborn
cases needing higher level of newborn care.

WHEREAS, the PARTNER OBSTETRICIAN shall be Philippine Health Insurance Corporation (


PhilHealth ) accredited physician.

WHEREAS, both parties have agreed that the PARTNER OBSTETRICIAN shall accept patients
referred by the SERVICE PROVIDER and provide appropriate care to all patients. This
agreement is valid from January 2017-December 2017.

NOW THEREFORE, for and in consideration of the foregoing premises, the herein PARTIES
have agreed to the following terms and condition.

TERMS AND CONDITION

Article 1
Definition of Terms
1. The Maternity Care Package is a Philhealth Outpatient Benefit Package that covers payment
fpr the following services for the first, second third and fourth low risk pregnancies, prenatal care,
normal birth, routine newborn care, postpartum care and familly planning, rendered by the
Philheath - accredited Outpatient Clinic.

2. Low- risk newborn is a newborn with no identified risk factor and abnormalities. The infant is
born spontaneously in the vertex position between thirty seven(37) and forty(40) completed
weeks of pregnancy.

3. Partner Pediatrician is a Philhealth - accredited professional that will accept all newborn cases
needing high level of pediatric care and treatment.

4. The Service Provider is an outpatient clinic duly accredited by Philhealth for the Maternity
Care Package. It is non-hospital outpatient facility with adequate facilities and competent trained
staff capable of providing all maternal and neonatal services.

5. Referral is the process by which the service provider directs that patient to the referral hospital
due to onset of risk, for further management of patients care rendered by the partner obstetrician.

Article II
Obligation of the SERVICE PROVIDER

1. The SERVICE PROVIDER shall render prenatal, birth delivery, routine newborn care, and
postpartum services to female beneficiaries during their first, second, third and fourth low risk
pregnancies and normal deliveries.

2. The SERVICE PROVIDER shall be available to attend to all eligible patients all the time,
especially during intrapartum and care of the newborn.

3. The SERVICE PROVIDER shall be available abide and comply with prescribed clinical
pathways and practices guidelines for Maternity Care Package.

4. The SERVICE PROVIDER shall do a rapid assessment of the newborn to detect abnormalities
that needs immediate referral such as:
4.1 Meconium Stained newborn
4.2 Small for Gestational Age
4.3 With congenital anomaly
4.4 Mother with History of Infection
4.5 Mother positive to hepatitis
4.6 Hypoxic newborn
4.7 Newborn who cant breastfed
4.8 Preterm baby
4.9 Poor APGAR score
4.10 Other risk factors that may arise after the baby that is out that the midwife percieves to
warrant Referral to a Pediatrician for further management.

5. In all cases of referrals, the SERVICE PROVIDER shall accurately accomplish the referral
form. Moreover, the SERVICE PROVIDER shall physically present when making referral to the
physician.

6. The SERVICE PROVIDER is autonomous, and has direct responsibility and liability for his
judgment and action.
Article III
Obligations of the Partner Obstetrician

1. The Partner Pediatrician shall accept all patients properly referred by SERVICE PROVIDER.

2. The Partner Pediatrician shall accept referral on a 24-Hour basis for newborn emergency cases.

3. The Partner Pediatrician shall entitled to reimbursement of claims in accordance with existing
NHIP in patient benefits but not under the Maternity Care Package.

Article IV
Common Provisions

The herein PARTIES agree that their attendance to the patients shall be independent of each other,
hence, each party shall be individually responsible for any incident that may occur during the
time that the patients is under his\her care. The determination of liabilities of both PARTIES in
the care of patient shall depend upon the specific factual circumstances of the case.

IN WITNESS WHEREOF, the PARTIES have set their hand to the MEMORANDUM OF
AGREEMENT at place and date written below.

FIRST PARTY SECOND PARTY

CHARIS JOY R. DOONG, RM RN JOEYLIN ABASOLO-PARCON,MD,DPPS


Clinic Manager Partner Pediatrician

Signed in the Presence of:

RIGOR K. ALVARADO,RN CHRISTINE MAE D. MARAGGUN,RN

ACKNOWLEDGEMENT
Republic of the Philippine
Kidapawan City

Before me this day of 20 , personally appeared


Affiliated with
Community tax no. Issued in
Dated both known to me to be the same persons who executed the
foregoing instrument and acknowledged the same to me to their free act and deed.

WITNESS MY HAND AND SEAL Notary Public


Doc. No.
Page No.
Book No.
Series of.