Scribd Logo
Upload

Welcome to Scribd!

  • 16K views

    Memorandum of Agreement

    Uploaded by

    macky symprano
    This Memorandum of Agreement establishes a partnership between a maternity clinic, referral hospital, and partner physicians to facilitate care for pregnant women. The clinic will provide prenatal, delivery, and postnatal care for low-risk pregnancies, referring high-risk cases to the hospital and physicians. The physicians will coordinate referrals and the hospital will accept all referrals. Together the partners aim to maximize healthcare benefits for patients.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd

    Memorandum of Agreement

    Uploaded by

    macky symprano
    16K views5 pages
    This Memorandum of Agreement establishes a partnership between a maternity clinic, referral hospital, and partner physicians to facilitate care for pregnant women. The clinic will provide prenatal, delivery, and postnatal care for low-risk pregnancies, referring high-risk cases to the hospital and physicians. The physicians will coordinate referrals and the hospital will accept all referrals. Together the partners aim to maximize healthcare benefits for patients.

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This Memorandum of Agreement establishes a partnership between a maternity clinic, referral hospital, and partner physicians to facilitate care for pregnant women. The clinic will provide prenatal, delivery, and postnatal care for low-risk pregnancies, referring high-risk cases to the hospital and physicians. The physicians will coordinate referrals and the hospital will accept all referrals. Together the partners aim to maximize healthcare benefits for patients.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    16K views5 pages

    Memorandum of Agreement

    Uploaded by

    macky symprano
    This Memorandum of Agreement establishes a partnership between a maternity clinic, referral hospital, and partner physicians to facilitate care for pregnant women. The clinic will provide prenatal, delivery, and postnatal care for low-risk pregnancies, referring high-risk cases to the hospital and physicians. The physicians will coordinate referrals and the hospital will accept all referrals. Together the partners aim to maximize healthcare benefits for patients.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 5
    At a glance
    Powered by AI
    The key takeaways are that this memorandum of agreement establishes a partnership between a maternity clinic, partner physicians, and a referral hospital to facilitate referrals of high-risk pregnancies to the hospital in order to maximize PhilHealth benefits and provide better care.

    The purpose of the memorandum of agreement is to extend the referral hospital's accreditation to the service provider in relation to high-risk pregnancy cases so they can be properly managed at the hospital.

    The service provider's obligations include properly screening patients, identifying those with risk factors, coordinating with partner physicians, and referring high-risk cases to the referral hospital in a timely manner.

    MEMORANDUM OF AGREEMENT

    This Memorandum of Agreement executed on this _____Date -


    ________ at Silang Cavite, Philippines by and between.
    JULLIENNE LYING-IN AND MATERNITY CLINIC, a business entity
    duly registered with the Department of Trade and Industry with business
    address at Block 36 Lot 9 Xone 11 AFP Housing, Bulihan, Silang, Cavite
    and represented by the ownier / sole proprietor RODELIZA FRENANDEZ
    EMPIALES, hereinafter referred to as the “SERVICE PROVIDER”
    and
    NAME OF HOSPITAL, a medical and a corporate entity duly registered
    in accordance with the laws of the Republic of the Philippines with
    business at KM 43 By Pass, Silang, Cavite represented by its MEDICAL
    DIRECTOR, NAME OF DOCTOR/OWNER, hereinafter referred to as the
    REFERRAL HOSPITAL;
    and
    NAME OF OB-GYNE, a medical practitioner (OBSTETRICIAN-
    GYNECOLOGIST) with licensed number_______, and NAME OF
    PEDIATRICIAN, a medical practitioner (PEDIATRICIAN) with License No.
    ________, both are presently affiliated at name of hospital, hereinafter
    referred to as the “PARTNER PHYSICIANS”.
    Witnesseth
    WHEREAS, Jullienne Lying-In and Maternity Clinic (SERVICE
    PROVIDER) is engaged in the service of providing maternity care to
    pregnant women offering prenatal, midwife-assisted delivery and post
    natal care to mothers and newborns;
    WHEREAS, there are onset risk cases which the SERVICE PROVIDER
    can handle better with the help of professional medical practitioners after
    examination of patients and determination that they will require further
    adept medical supervision for both mothers and newborns;
    WHEREAS, the parties herto – the SERVICE PROVIDER and PARTNER
    PHYSICIANS forge a partnership concerning onset risk cases to facilitate
    patients admission to the REFERRAL HOSPITAL bearing in mind the best
    interest of the mother and the unborn or newborn, as the case may be;
    WHEREAS, all onset risk cases handled by herein SERVICE
    PROVIDER and PARTNER PHYSICIANS shall be exclusively referred to the
    REFERRAL HOSPITAL subject to Philhealth membership of patients or
    beneficiaries;
    WHEREAS, the trilateral relationship is meant to maximize the
    Maternity Care Package available to Philhealth members and their
    beneficiaries and make available its availment to a wider patient base;
    WHEREAS, essentially, the purpose of this Memorandum of
    Agreement is to extend the REFERRAL HOSPITAL’S accreditation use to
    the SERVICE PROVIDER in relation to onset risk cases.
    NOW THEREFORE, for and in consideration of the foregoing
    premises, the hereinafter parties have agreed to the following terms and
    conditions.

    TERMS AND CONDITIONS


    Article I
    DEFINITIONS OF TERMS
    1. The Maternity Care Package is a PhilHealth Outpatient Benefit
    Package that covers payment for the following services for the first
    and second low-risk pregnancies, prenatal care, normal birth,
    routine newborn care, postpartum care, and family planning,
    rendered by the PhilHealth-Accredited Outpatient Clinic.

    2. Low-risk pregnancy with no identified risk factors. Normal birth is


    defined as spontaneous is onset, low-risk at the start of the labor,
    and remaining so throughout labor and delivery. The infant is born
    spontaneously in the vertex position between 37 and 40 completed
    weeks pregnancy. After birth, mother and infant are in good
    condition.

    3. The REFERRAL HOSPITAL is a PhilHealth-Accredited secondary or


    tertiary hospital equipped with state-of-the-art medical instruments
    and equipments needed for the management of obstetric or
    newborn complications.

    4. The SERVICE PROVIDER is an outpatient and a business entity


    known as JULLIENNE LYIN-IN AND MATERNITY CLINIC duly accredited
    by PhilHealth for the Maternity Care Package. It is non-hospital
    outpatient facility with adequate facilities and competently trained
    staff capable of providing all the maternal and neonatal services.

    5. REFERRAL is the process by which the SERVICE PROVIDER directs


    the patient to the REFERRAL HOSPITAL due to onset risk, for further
    management of patient’s care.

    6. PARTNER PHYSICISIANs are highly qualified medical practitioners in


    their own field of profession (OBSTETRICIAN-GYNECOLOGY and
    PEDIATRICIANS) who will provide further management of the mother
    and the new-born baby.

    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 and second low-risk pregnancies and
    normal deliveries.

    2. The SERVICE PROVIDER shall be available to attend to all patients at


    all times, especially during intra-partum.

    3. The SERVICE PROVIDER shall be abide by/comply with the


    prescribed clinical pathways and practices guidelines for the
    Maternity Care Package.

    4. The SERVICE PROVIDERshall do a pregnancy risk during the first


    prenatal visit of the patient.

    5. The SERVICE PROVIDER shall provide ambulance/vehicle to


    transport patients to the referral hospital should an emergency
    arise related to complaints on obstetric/gynecological/neonatal
    cases.

    Article III
    OBLIGATION OF PARTNER PHYSICIAN
    1. The PARTNER PHYSICIANS in their own judgment and direction
    coordinate with the SERVICE PROVIDER of any patients who
    presents with any of the EXCLUSIO CRITERIA and if necessary shall
    refer the patients to the REFERRAL HOSPITAL for Obstetric
    complication and at the soonest possible time.
    1.1 History of previous major obstetric/gynecologic operative
    interventions (e.g. caesarian Section, Salpingectomy for ectopic
    pregnancy, Oephorectomy).
    1.2 History of three (3) or more miscarriages, or one (1) stillbirth.
    1.3 Maternal age under 19 years old.
    1.4 Elderly primis with maternal age of 35 years old.
    1.5 Multiple pregnancy (e.g. twins, triplets, etc.,)
    1.6 Abnormal fetal presentation (e.g. breech)
    1.7 Placenta abnormalities (e.g. low-lying placenta, placenta previa)
    1.8 Uterine abnormalities (e.g. myoma uteri)
    1.9 Ovarian abnormalities (e.g. ovarian cyst)
    1.10 History of medical conditions (e.g. hypertension, heart
    disease, diabetes, thyroid disorders, obesity, moderate-serve
    asthma, pre-eclampsia, epilepsy, bleeding disorders)
    1.11 Other risk factors that may arise during present pregnancy
    (e.g. premature contractions, vaginal bleeding), that the midwife
    perceives to warrant a referral to an obstetrician / physician for
    further management.
    2. The PARTNER PHYSICIAN and with the conformity of the REFERRAL
    HOSPITAL is authorized to endorsed the patient of the SERVICE
    PROVIDER.

    Article IV
    OBLIGATIONS OF THE REFERRAL HOSPITAL
    1. The REFERRAL HOSPITAL shall accept ALL patients properly referred
    by the SERVICE PROVIDER.

    2. The REFERRAL HOSPITAL shall accept referrals on a 24-hour basis


    for obstetric / gynecologic/ neonatal emergency cases.

    3. The REFERRAL HOSPITAL shall be entitled to reimbursement of


    claims in accordance with existing NHIP in-patient benefits.

    Article V
    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 the patient is
    under his/her care. The determination of the liabilities of PARTIES in the
    care of the patients shall depend upon the specific factual circumstance
    all around the patients.

    IN WITNESS WHEREOF, the parties have hereunto signed this


    MEMORANDUM OF AGREEMENT this _______Date_______ in Silang, Cavite.

    Signed in behalf of the Service Provider RODELIZA F. EMPIALES


    Jullienne Lying-in and Maternity
    Clinic

    Signed in behalf of Referral Hospital NAME OF


    DIRECTOR/OWNER
    Referral Hospital’s Name

    Signed in behalf of the Partner Physician NAME OF THE DOCTOR


    Obstetrician –
    Gynecologist

    NAME OF THE DOCTOR


    Pediatrician
    WITNESS:
    ______________________________
    _______________________________

    ACKNOWLEDGEMENT
    REPUBLIC OF THE PHILIPPINES
    SILANG, CAVITE
    BEFORE ME, this ____Date_ in the Municipality of Silang, Cavite,
    personally appeared the following persons:
    NAME PRC License No.
    RODELIZA F. EMPIALES _____________
    NAME OF DIRECTOR _____________
    NAME OF OB-GYNE _____________
    NAME OF PEDIATRICIAN _____________
    known to me and to be the same persons who executed the foregoing
    instruments, and acknowledged to me that the same is their voluntary act
    and deed.
    These instruments consisting of four (4) pages, has been signed on
    the left margin of each and every page thereof by the parties and their
    witness, and sealed with my notarial seal.
    WITNESS MY HAND AND SEAL in the place and on the date first
    above written.

    Doc No. ____________


    Page No. ____________
    Book No. ____________
    Series of 2010

    You might also like