Repwblic of tbe PhiliPPines

PHILIPPINE HEATTH INSURANCE CORPORATION

Ciq,r1o,. Cenlre Building, 709 Shaw Boulevard, Pasig City
r$p
f
Healrhl-ne 44 I 7 444 uau.t.p.ldxal$-eal-Ph

l\'larch 3,2014

PFI]]-FIEALTH CIRCULAR
No. 010 , s-2014

rogd: AI-L HEAITH

CONCERNED
CARE PROVIDERS AND AIL OTHERS

SUBIECT The New Accreditation Ptocess fot Health Care Professionals and
Guidelines for Credentialing and Privileging of Professionals

I. RATIONAI,E:

Pursuant to t-he new poJicies issued b)' the Corpotation rncludtng the Implemenu:rg
Rules and Regulations of Repubhc Act @-a) 10606, r, act amending the Nationai Health
InsuLance Act of 1995 (RA 7875, as amende d) and the All Case Rates Policy No. 1 -
Governing Po[cies in the Shrft of Providet Pa-r,Lrent Mechar-ristn frorn Fee for Seffice to
Case-pal,rient Mecharris'r phiiFleaith Circular No. 31 s. 2013), it is impetative that reforms
Care Professionals must be estabhshed as dre Corporation pursues t1're
- n..r.drt-g Health
aspiradons Jl Kr/,.,n go, Pangkalahalan or Universal Health Cate Moreor,et, it is also the
responsib rti of the totpot"tion to rendeL fast afld efflcient sen'ice to its stakeholders by
simpLihed pro..drr., and requir.ernents conslstent with the Antl-Red Tape Act of
^dopdng o+ss;. rns dir.ective has gurded the corporation in updathg its procedures in
200; Gii
engaging the Health Care Institutrons rn 2012'

In Yieu, of the foregornS the corporation endear.oLs to inptove the accteditation

process for health care prof..iio.r^1s to ensufe t1,at members of the Natronal Health
'Irrr,]ror..
Program (NHIP) and t1:eil dependents have better access to qualig' and cost-
effective health cate set-r'ices.

II. OBJECTIVES

The nev accreditation process for ptofessionals aims to:

1. Estab[sh a strearrrliled and effecove process 1n accrediting health care professioflals for
drc NHII
2. Strengthen the monitoring sl'stem for PhtlHealth accredited l-realth care professionals
3. Recoiamend guidelines ior heait1r care institutions ir.r its cteder.rtialing and pnv eglng ol'
rts hcalth care professlonals

PaEe 7 af 7
III. COVERAGE

This circular shall apply to all hea.lth care professionais that ale curtendy partrcipatrng
as well as those witir intention to participate in the NHIP These include:

1 Pl.rysicians
2 Denrists
3. Midrvlves
4. Othel health care professionals as deterrnined by PhilHealth

This circular shall also app\' 56 thc health care institutions where these health care
pro fes sionals arc aff:liated.

IV. DEFINITION OF TERMS

1. Affilianon Is a ptocess by w]]Llch a health care irstitution accePts a health care

professional as part o-f their health human resouLce and ifl so dolng provides the health
Lare ptofessional practice plivileges rn thet healtl care mstltutLon
2. Coninuous accr.editation g1vefl to accredited i:ealth care ptoviders under basic
participation provided that thq' compiy wlth the requirements annually as presffibed by
th" Cotpotrtioo. Continuous accteditadon provides them ur nteffupted participation to
th. progr^m but tlus privilege may be withdrarvn at an)r tirne based on n:1es set by the
Corporation.
:. CreientLaling the process establisl'red bv a health care institution to obtzrin, vedE/, z,,d
-
assess tl.'e q;ulifi.oaorr, of a health care professional who apphes for
affiliation rvtth thejr
111S t1tut10 n.
4. Perforrnance corrrmitment €c) - , document signed bt health care professionals who
intend to participate ir.r uhe Program, r.r.hicl.r stipulates their undertakings to provide
corrrple te o.ra qr"tiq, I'realth sen ices to PhllHealth mer:'rbers and their-
dependents. This
docu,-rent also ieflects tl-re u,illi.gness of health care provider to compl1'with
PhilHealth
poLicies on benefits payment, rnfo,rmation technolog;', data management
and reportillg and
referal, among others
5. privileging tLe process of gfi,rng appropr.iate practice prir.ileges or beneflts to hea]th
care

prof"rlioinl, af6\t ted v,rth &e health care institution based on certain status, ctedentia-ls
or qualifications.

V. GENERAL GUIDELINES

l,TIrefol]owingprofessionals,whoareJicensedbytheProfessionalRegulauon
Commission,areautomatica}lyaccteditedandcouldparticrpateintheNHIPprortded
that they submit the required documents (Annex A) that tncludes, amoflg otl-rets, the
signed Perforn-ratlce Commitment (PC), to the nealest PhjlHeal& offlce:
a. l'lrl siciarr:
b. Midrvl'es
c. Dentists
d. Othet professionals as deterrnired bl the Corporetion
:. The accreiitadon ptoccss for health crre profcssionals shall be streandined tl'rougb the
follorving mecl'ranis ms:

PaEe2 ol7
 Delegatrng the authority to PhjlHeal& Regronal Offices (?ROs) to process all
nppilntioi, for accreditation of health care professionals and to update d:eir profiles
h PhilHealth database.
b. Delegatrng the author-ity to the Chauperson of the - A-ccreditation Committee to
,pprJr,. o.-, deny d1s Mot-ions for Reconsideration, includ:ng the authority to act o11
unresoh,ed accreditation issues of health care professionals refetted by the
PROs to
the Committee.
c. Instirutionalizing the condnuous accreditation, until withdtawn, for health care
ptofessionals
Heajtl, Car:e professionals may sub.rt thet' application for imtral accteditation and
re-
accreditation at an1, dme of the year. These professionals may opt to pay the premiul
OR-
contribution of the rer:-raining applicable quarter,/s of t-he current )rear Plus """ {:1
fov tl'r. ,"rrtrirrirrg appJ-icaJ:Le"quar ter/s oi the
current ye plus 2 years The validitl'of
i..r"drtntio., of i1.t" professionals shail statt from the day of submission of complete
requirements and ends one day pdor to the plofessioflai's bir:th date'
,rU1 HCPS must declare their membership :r1] a nattonal
association, which is an Accredited
Professronal Orgarizaion by the Professionai Reguladon Commission
(PRC) Physicians'
likeu'ise, must dlchre their membership rn a specialty society tecogn'ized by the-Philipplne
lVledical Association. Health .uti prolessionals must tecogruze that thet
association/society plays a role rn their continuing education and ln
regulanng thel-
profession.
itt t.nttt care professionals sha11 undergo ctedentialing and privileging by its affiliated
health cate instrtutron/s.
A11 currently accredited professionals shall sign and submit &e PC (An-nex
B) on their
srlbseqoent fit continuous accreditation The Warranties of Accteditation that
^pplicatron
a.'.yt,*..ig,,.a.n^lremailr,aliduntilthe;,renewtheir'accreditation.Professionalswho
f"t re"oc.r.ditation and rn.rtral accreditadon horvever, shall submrt and sign the PC
^fply
upon the effecuvig' of this Circular'
Pirr-r-r.rr, of a...editntio., fee and cetificate of good standiflg
from the national
are no longet tequired
association of professionals and/or specialti' socieq' 6p p1-rytitians
i"r ^fffr*ai"" for accreditation. Ht"utt"r, t-he nan'res of the ptofessionals must be
,.n".,..a in the database of tlreir respectir,e natjonaj associadon and/or specialq, society
declared in their PC.
The vdidrq' period of accreditadon of all professionals applyrng for continuous
ma1' opt to pa)I
acdeditado; rhrl b" o rirrimurt of 1 ,:'eat and maximum of 3 yeats They
shall be the basis of
tl,eir-premiurn contdbutions equrvaleni fot 1tear,2 or 3 1'ears, vhich
the acctedrtation validlry to be granted for the professional'
requfements
Curlently accredited health care p;:ofessionals shall submit the documentary
to
not laterl than 45 days p1le1 to t-heir birthday to ensufe their conti,uous accreditadon
NHIP, Failu::e to submit the requirements withln the prescribed period shall
lt:'I 1th"
$,'rthdrau.al of their continuo... u..r.ditntio" Accredited professionals
shall iflform
to a11ow
PhiHealth itrmedi.ately of anl' changes in their- Personal Data Record (Annex C)
Phrlhcalth to update their record in the Co;:potation's database'
10. AManualofProceduresandirrrplerrrentirrgguidel-rnessha]]beissuedtofacilitatedre
implernentarion of I}-rs Cu-culrr'

Page 3 of 7
 OF
VI. GUIDELINES ON CREDENTIATING AND PRIVILEGING
PROFESSIONALS

CtedentraLing and privilegingof health care .pro fessionals shall be done b1' the health
all fiealth care ilstitutions must establish the
care institutions whete thel' o" Ttfyo"a Thus'
and tt "-
Lnechanjsm to relt!' thc cepabilir.ies qualificerions .cotnpetenct;'rte relldered
-,1:11'l^t:J'
to r-ne
f-f.tti"*f If done properly'tt"tl"Nfip tyttt* ensures draL qualiw set-vtces
The following tht of the professionals'
membets and dependents ot "t 'o1"t of ctedentiaLing and
l-realth care institutions urd
pt il]-l.olti, to ensufe prop.t:i-plt-""tation
ptivilegrng,

A. Roles of Professionals
l.H6althCa,"P,ofessro,,n1ss1ral]submittl'rei.r'crederrrialstotlrehealtlrcareilstitutjons
thel rre afhlirred with legitimate, valid
l. HcllLlr C:rtc Plofcsstonals tnust ensule that all their ctedentials are
and uPdated.
3.Healt-hCareProfessionalsmustensuletlrattheymaintaintheirgoodstandrrrgwith
PRC lecogruzed plo fessional orgaruzi]Eon

B. Roles of Health Care Institutions

sha1l develop thet own set of policies and
' A1I accredited t.r-ttt .ur" irrrtitr:tlons
1.
health care professionals'
g*a.fr"* iot cr.denti^Li"g *a po"'ftg-g .therr,af?ihatedrecogrrized accredlti:rg bodies'
They may adopt from t'f'*g pa',.i"J eidorsed-by
The folloung shall be t""tlai*a by the HCIs
in formularng their policy in
credenrialing a"ndpri'iltglng"orheah'h calc professionals: ,
the primary source(s)'
;. i;;t4, it " .r.a".ttio-tt healtt't care professionrls from
educadon' ilternship' residency' and
These ctedential' ttto'rrpo" p'ofts'rin'l
fellowshrp Programs otht'-"l"t'""t tralmgs and rvork expedence'
^'d: of rnformanon for credentialing and privilegrng
b. Thc recogniz.a p'muT 'o"tt'
includc, among othets:
r l!{edical Scl.rools/Professional school accredited by the Commtsston on
Hrgirer Education
. ProfessionalReguiatoll' Comnrission
r Trahir-rg Hospital or Institution
. SPecialq' Board
r National Associadon of Heaith Care Professionals
o Other hospltal affiJranons of Healtir Care Professional
be verifled are as lollows
c. The crittcal crederitlaLmg parameters that rrrust
o Cuuent license
o E.ducruon and urinhg
. ExPerience, abrhq' and curreflt competence
2. The HCI shall conduct t'Jd""tioJ:"g o"d pii"iltg''g of all its affihated health
professionals
j." privileges consisteflt with dre
The HCI shall set the vahdlq'period for conferred
such pr-ivileges are suspended'
t i.rr,. ofhealth.u," p'oft"iol''is unless
4. The HCIs shall rnandate theu affrl'rated healtl]
cari ptofessionels to update their
Phr1Hea1t1.r accreditatron as part of their
ctedentialing and privilegrag policy Futher'

Page 4 of 7
 to become
the HCIs shall enioin thet resident-physicians znd conttacted physicians
PhrlHerluh membet'and encourage thetn to ger eccredired'
5. The HCI shali keep a record, Joot"tt oi its equrvalent (N4OA'
etc) of all, PRC-
l.gtrt.t.d healthcari professionals who have undergone credentialing and privilegrng'
inltrai"g tJrc pracrice privrJeges confer:r-ed ro dretn
related to
6. The HiI ,t rU olow Phdilealth to le\dew all submrtted documents
.r.d.rn^t:ttg and ptir':leging duting the co:rduct of their morutorkrg of
the HCI
,rrro.y, nrrd-*h.rever deemed flecesszry/ by the Corporatron'
Z. FICfr' shall recognize the role of PilC-recoprzed national
association/specialty
socieg, ef health care professionals in ensiurng their continuous ptofessional
education and ovetseeing tl.reir practice standards'
g. The accredired HCI, hai,ing .o.rf.r."d t1-re ptvrlege to their healthcare professionals,
shall be l]eld accountable to Pl.ilHealth for any repotts
of non-compliance to
ptljfff .nttt't policies, including those related to the qualrq' of healti.t delvery'
9. Vio1alons of the P.rfor}ance Commitment comrrritted
by the healthcate
where such praclice was noted Aftet
professional ma1' be counted agzrnst the-HCI
ir..t. p.o..rr, tfr. I{CI sha1l be issued offense warnings
and subsequentiy suffer the
penalties or sanctions in accordance with Ph Health
implementrng
.orr.'rpo.di.g
rules and regulations and other perdnent issuances
10. In case the health cate profe'ssionals r'-e aiso t:rembers
of the credentialhg and
ntrvileslns .ot^r-rirr.", ^'LhoLiry' en add:tronrl provision oI
r]-re Per-formance
'c;r;;d.", shal.l be slgned by the said professionals to declare such atrangeffrents

from which may arise conflict of intelest'

C. Roles of PhilHealth
af{itated professionals of
1. PhilHealth shall vetifi' the credentials aod pflvileges. of
and other quality assutance
HCIs during healthcare ptovider peLfoLmance monitoring
activities.
-orporn,lon of documents
Z. ifr" shall valjdate with the issuing office the au&entlcity
submrtted for accreditation as deemed necesszry'
3. Ph:iHeaith Lesetles the right to rvr&drau'fie accteditation
of any HCI which does
not conduct credentialirg and privilegrng of its professionals'

GROUNDS FOR WITHDRA'X/AI OF CONTINUOUS

ACCREDITATION OF
VII.
PROFESSIONAIS

Accreditatiotl is a privilege granted b1'PhrlHealth to health

czr:e professionals t1:at
continuously particrpate until
app\, for accreditation. Thes. i..i"edrt.d professionals may
.iili n..r.ditotion is withdras'n by Ph:lHealth on the following grounds:
fJlng pedod
1. Non-subrrrission of all &e required documents on the prescribed
2. Offrcial declaration o,,q'"lily7tthi"'l issues endotsed by the national association
gor.erning the practice of the proflessional after due process
Otlrciat declaraflon on qu"Liqv/tthital issues endorsed by
3. the specialq' socieq'

governing the practice of the physlcian after due ptocess

4. bther reasons as detenrriled by the Corporanon

Page 5 of 7
VIII. MONITORING AND EVAIUATION OF PERFORMANCE OF
PROFESSIONAIS
A11 acctedited HCIs having committed to comply with all PhilHealth rules
and
regulations shall assist PhilHealth in rnonitoling the practices of their aff,Iiated health care

pr"ofessional,'Anymonitor-rngfirrdirrgstelatedtot}eptacticeoftheprofessional,.goodor
otlr.r*i.., shall also b. refl.cted 11r the HCI prof,le and shal] be used as one of the bases for
the fac rty's condnuous accreditation and performance assessment'

Al]accteditedprofessionalsshallbesubjectedtothesamemonitorirrgcttexta.abeady
supuhted h Section 4i it rr .. of the new IRR that includes, among others, the following:

o Over utilization of serices;

r Unnecessar], diagnostic and therapeutic procedures and interr,entions;
. lrradonal medication and ptesc..-iptions;
. InapProPriate referal practices
r GrosslJ, unjusrifled deviations from cuffently accepted standatds of ptacice andf or
gurdeliles or tleaunent protocols
. Use of fake, adulterated ot misbranded phatmaceuticals or uruegisteted dflrgs;
o Use of drugs other than those prescribed in the latest PNF and those for which
exefilptions were granted by the Board

Other violations include:

o Llnsafe ptactices (e g use of unsteri-Iized instruments )
. Unethical/ Questionable practice patterns
AfeedbackmechanismshallbeestablislredbyPh:-IHeaithtoinforrrrthehealthcare
negatiYe morutoring
ptofessional of the monitorilg findings. Health cate .professionals r.vith
'findings
shall be subjected tJ a peei;:eview tluough the QAC, the results of
w}ich may
constitute an offense or r.iolition of their perfomance comrrritrnent. Upon the
recommend.adonoftheCommittee,suchtesu]tsshallalsobeteportedtotheiraffrliate
pRC for other apPropdate actron
nationai associanon/ speciaity sociery, PNLA afld
Nloreot,er,theHCirrh"r.ro.hpracticewasobsen'edshallbetaggedfortl-resameoffense'
Three(3)offensesslral]tdggelsancbons,consistentr,viththepror.lsionsstipulatedrn-PC54s.
2012. ia.cuor.rs nrrd p.rnil"., as provided in thc Perfor'rance Comlitrnent for
professionals
shall also be apphe d as detelmined bv the Corporation'

r\llotlrerr,iolationsofthePerformanceCon'rmitmentsha]]alsobedealtwith
accordingiy'Sucir|rndingsofr.iolationsbi'theconcernedPRoshallbedrrecdi'reportedto
professionals and HCIs, \vhere the violation was
thet, leg;1'umt for apprlprlzte actiofl,
committed., shal] be meted t]re same perralties as pror.ided br. existtrrg
1aws,.r.uIes end
tegl1lntro"s, particular-\' those provLded by Rep Act No 7815' as Amended'
and its
Implernenting Rules and Regulations '

VIII. SANCTIONS AND PENAITIES

Ani' violation of tlls Ctcular, the tetrrs and condidons of the Performance
cuculars, of6ce otders and directives shall be
Comlritment and all exisring related PhilHealth
by RA 10606
dealt witl] in accordance witl the pertinent pror.isions of R-{ 7875, as
amended
and its Implementtng Rules and Regulations'

Page 6 ot 7
REPEAIING CLAUSE
this
A11 previous PhilHealth issuance inconsistent or contrary to the ptowisions ,of
accordingly- All provisions of
Circuiat ate'heteby revised, modified, repealed or resclnded
sha11 remain valid and in effect'
.-o*irrg irrl..rrr.". .ir"h u,. ,ot 'ffected by tlus Circular

EFFECTIYITY

CAGIiFi*N TRUI I}OPY

Page 7 of 7
 ANNEX A
Type of professional Requirernents for initial Requirements for Requirements for te- Rernatks
accteditation continuous accreditation (upgrading
accreditation and re- from GP to MS)
accteditation due to (applicable for physicians
gp only)
1. Physicians
a. Geretd Practrtioner . Provider Data Record . Provrder Dara Recotd . Provider Deta Record for A physrcian shall
for professionals for professionals professionals only submit a
. Per:formance . Perfo!_mance . Perfomance Commitrnent certificate of
Commitmeflt Commitment . Updated PRC license or its Compieted
. . Updated PRC license Residency
Updated PRC license alternative
.1x1photo Trainirrg if he/she
or its altenative 01 its aitemative 2
.1r1photo-2 wishes to be re-
.1x1photo-2 . Proof ofPaymeflt of
classified as GP
. Proof ofPayment of . Proof of Pa)-nneot of Premium Contribut.ion(y'
with taining
Premium Contliburion Premium Contribution app/icalio n * for udinzrottt
accreditalion axd rpgrading at tbe

. Specralty Board CerbEcate

b. Geoelal pract-rtroner . Provrder Data Record . Provider Data Record . Plor.ider Data Record for
rvirl-r trninirrg for professiorals for ptofessronals proFessionals
. Performance .Performance . Pelformance Comrnitment
Commitmeot Commitment . Updated PRC license or its
' UPdated PRC license ' Updated PRC license alternatrve
or its alternatir.e or its alter-native . 1{ l photo-2
. 1r 1 photo 2 .1x'lphoto-2 . Proof of Payment of
. Proof ofPayment of . Ploof of Payment of Prerlrium Cor-ttdbution
Premium Contribution Premium Contribution . Specialty Board Certifrcate
. Completed Residetcv
Training Certifrcate

c. NIedical Special.ist o Providet Data Record . Prowider Data Record

for professionals for professionals
. Performance . Pelformaflce
C omrnitrnent Comrnitment
. UPdated PRC license or . Updated PRC [cense
its alteroative or its alternative
. 1x 1 photo 2 .1x1photo-2
. Proof of ?ayment of . Proof of Paymeot of
Premium Contribution Premium Contribution
. Specialt,v Board
Certificate
 /^)

2. Midwives . Provider Data Recotd for professionals o Provider Data Recotd for professionals
. Perfotmafl ce Commitment . Performance Comrniunent
o PRC license or its alternative . PRC license or its altemative
.1x pieces
.1x1photo-2pieces
1 Photo -2 . Proof of Payment of Ptemium
. Proof of Pa)rment of Premium Contribution
. Any of the following evidences of Competency on Contribution
for o MOA with any of the following as referral
tl,e Expanded Functions of Midvives (not required
graduates ftom school year 1995 and onwards):
for complicated OB and Pediatric cases:
(OB and
i. Certiflcate of Training ftom a progtam accredited by 1. Accredited patmer physicians
Pedia)
rhe Continuing
2. Professional Education (C?E) Council of the Board 2. Intedocal Hea.lth Zone (ILI{Z) wlich
of Midwifery of the allows sharing of humal1 resoutce
3. DOH-certified BEmONC-CEmONC
3. ProfesslonaLRegulation C'ommission (PRC) or
4. Ttaining Certificate from DoH-recognDed ttaining network

Pro8fa1n, of
5, CertiEcate of Apptenticeship for one or more yeats
.rith a PHIC acctedited Obstetrician-Gynecologist or
an acoedited midwife done in an accredrted facrlity
. MOA ''ffrth any of the following as tefettal for
complicated OB and Pediauic cases:
1. Aicredited panner physicians (OB and Pedia)
2. Intedocal Health Zone (ILHZ) which allows sharing
of human resource
3. DOH-cerdFred BEmONC-CEmONC netwotk

.
-3- Dentists ffiiorr^1. .
Provider Data Record for ptofessionals
Perfotmance Commitment
. Performance Commitment
. Updared PRC license or its alternative . Updated ?RC license or lts altemauve
.1x1Photo-2 .1x1Photo-2
. Proof of Paymeflt of Premium Contdbution
.Proof of Payment of Premium
Contribution

{:,,ir :l-i !i: i !l ij} -l ::i !.! Ii i::i,1} il},{

 ANNEX B
5 Febmarl, 2014

PHILIPPINE HEAITH INSURANCE CORPORATION

17th FIa., Ciq,31u1. Centre Bldg.,
Shaw Bivd., Pasig City

SUBJECT : Perfotmance Commitment Fot Health Cate Professionals

Sit/Madam:

l-o guarantee ou1 cor.nmitment to the National Flealth Insurance Program ('NHIP'), I respectfully
submi. r l:is lerfolmance Colnrnirmcnt.

And for the puryoses of th,rs Perfotmance commitment, I hereby commit the followrng
representations:

1.7 I)octor of
Medrcine/Dentis t / Mid:vite / Phzrmacist duly registered and Iicensed to practice mY
profession by tle Ptofessionzl Regulation Comrissiofl @RC) wtth PRC No.

2. As a licensed professional, it is my tesponsibiJrg, that mI license is updated and vahd all the
trme

of the NHIP with an active membership in the NHIP by

3. I am a met'rbet rn good standrlg
reguiatly paying m1' PHIC ptemrum contlibutiofls during the entlte validrg, of my
accreditadon as a health care professional;

4. I am a membet rn good standing of (name of the national

association/ specialq, socieg) regulatrng mi' profession;

and have
5. I am afEhated with
(T',trame of acctedited HCI/O
undergone credentialing and given appropr-late pr-ivileges rn the said frsntuuon/s in
accordance with their poiicies and procedures.

6 I understand, that as a health care professional of dre said rnstltuuon/s, I will follou,: the
policies of the sard faoJrq' as loflg as it does not r.iolate Statutorl' laws, Orders, Circulars and
il,.h oth.r policies, n.rles and regulations issued b1' the DePartment of Health (DoH) and all
other go.,..rnm.nt agencies and jnstrumentalities gor.ernilg the practice of my ptofession.

7. Ihave read, understood and I am ful1y aware of the ptoyisions of Republic Act (R-4.)7875 as
zmeflded by R-a 10606 rncludr,.rg its Implementfrg Ru]es & Regulations paltlculady that
petaining io and gor.ern:ng tl'Ie extent and limits of the grant of my pdvrlege to be an
accredrteJ health care ptofessional of the NHIP admrrustered by the PHIC'

Furtlrer, I l.reteby commit myself to the following:

8. I shall conduct myseif str-ictly and faithfulty in accordance with the provisions of the
Repubhc Act 7875 as amended as the Nat-ional Health Insurance Law of the PhiJrppines
including all its Implementing Rules & Regulations (IRR);
circulars,
9, I shall strictly abide with all the irnplemennng r-ules and regulations, memorandum
officeorders,specialordersandotheradministtativeissuancesissuedbl,thePHIC
go\.effmg my accreditation;
rules
10. I shall strictly abide with all Admrnistrauve ordets, circulats and such other policies,
and tegulations issued by the Depattment of Health (DOH) and all other goveffment
rny
ag.ncie. and instmmentalities govetning the practice of my profession and affecdng
accredimrion in the \HIPI

i1. Ishallsuictlyadheteandabidewi&allthepetdnentStatl}tolylawsaffectingthepracticeof
Expanded
my profession and my participation rn the NHIP including, but not limited to' the
Seruor Citizens Act of 2003 E.A. 9257), the Breastfeeding Act (R-'A
7600)' the Newborn
ScreeningAct(8..A.9288),theCheaperMedicinesAct(R..A.9502),tlrePharmacyLaw(!..A.
5921), tlre Nlagna Czxta. fot Disabied Persons (RA 9442) and all other lau/s
that may
thereafter be passed by the Congress of the Philpprnes or 211y othet
authorized
instrumentaLities of the government.

12. IamfullyawateandlherebyacknowledgethataccteditationadministetedbythePHICis
not a flght but a mere pnvilege as provided under Section 31, Artrcle VIII of R'4
7875 ott

the 'A uthoriq, to Grant Accteditatron' by the PHIC;

13. I am ful1y aware and herebl' acknowledge that my accreditaaon being a mete privilege
I
extended b1, the NHIP, the grant of which may be continuous for as
long as I cornply with
the requiements within a particular period as may be deter:rnined by the PHIC
I furthet
acknowledge and accept that my accteditauon rnclud:lg the appurtenant
benefits and
and/or
opportufli;es incident thereto, being a mete privilege may be withdrawn' suspended
revoked ot any dme duflng the term of my accreditation as mav be determlned
by the PHIC
to protect the intetests of &e NHIP;

am fully aware and I unconditionall;' acknowledge and agree that non adherence
to
1+. I
gurdeLures ot an1, violation of an1' provision of my commitmeflt
whedrer direcdy or
Lair.".Ay, shall constitute 'Breach of the Perfortrance Commiunent' and sha11 be ground
a

at the discretion of the PHIC, to suspefld, shorten, pre teflTrinate and/or revoke my
accreditadon tncludrng the appurtefiant beneflts afrd opportunities lncident theleto
at afly
tirne dunng the tefln of ml' accreditation as may be detetrrrined b1' the PHIC to protect the

inreresrs of the \HlP;

undertake ti:zt all qualif,ed NHIP beneficiaries shall be grven hgh qualiq, of health
care
15. I
service due them without delal' 2v1;1 that I shall deduct without delay the
couect amount of
chargeable benefits due to qualified beneficiariep upon discharge;
 advetse
16. I am fu11y aware and I unconditionally acknowledge and agree that any indication(s)'
of any
,.portr/hrrding, of pattern(s) ot any other similar incident which may be indicative
itl"gu1, or.grl-, improper and/or unethical conduct or ptactice
of my ptofess.ion may be a
my
gro".r.rd ut di..retion of the PHIC, to susPefld, shoten, pre-termin ate andf or tevoke
L.
incident thereto at any
]..reditotron including the appurtenant bene{its and opportunities
trme during the tenn of my accredrtation as may be detetmined
by the PHIC to plotect d1e
rntetests of the NHIP;

17. I am ful1y awate, knowledgeable and hereby agree to strictly conduct m)rself in accordance
including all the
*ith in compliance to all the basic precepts and tenets of my ptofession
^nd ncludrng all the etlucal
Iaws, guidelines, policies and regulations regulatrrg my profession
standards required and governing the exercise of my profession;

and prorect r-h e NH I Proglam agairsr abuse' r'rolaaon and/or

over
18. I shalJ prornore
a party to zfly act, scheme,
urilization of its Funds and I will not allow oul institutjon to be
to the Ptogram;
plan ot contact thzt may directly ot indirectly be prejudlcial

nor direcrJy ol rnduectll engage in any form o[ unethjca]

or impropet precdces as ar
19. I shz-11

accredited providet such as but flot limited to solicitation

of patients for purposes of
under the NHIP the purpose and/ot the end considetation
of which tends
.o-p.rrrobil,ty'frour.iul
,o.J..rrur, rather than promotion of the NHIP theteby ultimately
gain
undermining the greater interests and noble purpose of the
NHIP;

20. T hereby undertake that T sha11immediately repol:t to the PHIC' its Officets and/or to any of
,t. p"r,orr.r.l, zn)'/ act(s) of i1ega1, rmproper and/ot unethical ptactices of
institutional or
have con-re to our klowledge
profes.iorr^l l't.oltl', ."r" pro"idttt of the NHIP that may
direcdy or hdirecdY;

21. promptly make available upofl request fot PHIC purposes' a listing
J sha11 immediatelv and
and authorized
of my schedule of professional fees teadilv available to PHIC Officers
personneL, membets, dependents and/or representatives;
aodf ot its
23. I unconditionalll' recognize the author:tq' of the PHIC' its officers and petsonnel
relative to the
dul), authorized rePresentatives to conduct administtative investigation
.r.t.i.. of my prlvitege and conduct of my professiofl as an acctedited health
cate
my profession' I ful1y rvelcome and
professional oi *r" Nt-ttp and knorving the diversiq' of
understand if t-he investigation shall be done beyond the normal
busiless/operating hours;

to be conducted
21. I undertake that I sha11 ful1y cooperate and submit myself to 2n)' assessmeflt
of utilzatron
by tire PHIC relative to any findrngs, adverse repolts, quality issues' pzttern
practice of my
andfot an1, other acts indicative of any illegal, furegular and/ot unethical
ptofession as an accredited healthcare professional of the NHIP
that ma;' be preiudicial or
tends to undermine the noble purpose of the NHIP;

I undeltake Lh:rt i slrrll cotnp\ wid:out delar any and al1 PHIC's
sul nons, subPoena,
li.
subpoena'duces tecum' and other legal processes;
l- t*I.l
,l .l

.tL1lt+. k
-r
' .. ':, :1 . -t :,.
_
-.1.
i:\;
26. Iundettake tfa t tirne during the period of my accreditation, upon tequest of the
^l ^ny
PHIC, I shall votuntarily and unconditionally sign and execute a new 'petformance
Faith and
comrnitment' to condnue my accreditation as the case may be, as a sign of my good
to
continuous dedication and sincetity to comply with my Petformance Comrnitrnent'
support and Ptomote the National Health Insutance Ptogram berng administeted by the

Phjlippine Health Insurance Corpotation.

a1e true
27. Finally, I heteby declzue undet penalties "f P€"ry that my above-stated statements
and cor:rect without any conditions and ftee from mistepresentations'

Very truly youts;

Ptofess.ional Provid e:-

PRC License Number
Expry Date

Additional Drovisio4-folfadliry-o

l.Iamtheappto.v:ngauthorityand/otmemberoftheCtedendalingandPnvileging
committee #*r. and privileging of the professionals of my/our institution
"r.a.otirtirrg on the
and have confered opoo oiy."lf iu,.l-il"gtt to practice the profession based
cedentials as certified by the profesiionrl iegulauon Comrnission @RC) and tle national
association of health cate ptofessionals recogn-ized by PRC'

l)l-:Ill{f;iilT
'ji:'r tj- i.!
Professional Providet
?RC License Number
,c*r-J P-* h,4,a--- I.1,:\. T Lj i1i .:r."A. eUtAOtT
Erpiry Date
-''' t'P17,1|u'tb
,.,, o'
,1: g,' ;; 11 ;' 1
r.frTFlil[[py
 Republic of the Philippines
PHILIPPINE HEALTH INSURANCE CORPORATION
City State 709 Shaw Blvd Pasig Cily
lealll \ line 44 1 -7 442, 441-7444; www.philhealth. gov.ph

HEALTH CARE PROFESSIONAL PROVIDER DATA RECORO

THE PRESIDENT & CEO

Phi{ippine Health Insurance Corporation
Pasig City,

Sir/Madam:

of legal age, hereby applies for accreditation under Sec. 52 of R.A.

7875 as amended by R.A 9241 and its implementing Rules and Regulations thereto. For this purpose, I hereby submit
the lollowing pertinent information and documentary requiremenis.
EALTH IDENTIFICATION NO.

EPhyslcian I lnitial E Re-accreditation

E General Practilioner (GP) f] Conlinuous

f] GP w/ Training

No /St./Brgy

Province

f6. Date lssued (mm/dd/yy) 7. Valid up to (mm/dd/yy)

18. RESIDENCY TRAINING (For Medical Specialist/ GP with Training)

of Hospitalr Address of HosP tall

OB

For PhilHealth Use Only

PRO

Date Received: PRO OR No.

PR
Date Paid:
Amt. Paid.
Date Encoded: (Data En1ry)