MEMORANDUM OF AGREEMENT

MALASAKIT CENTER PCSO DESK – PARTNER HOSPITAL

THE PUBLIC IS INFORMED:

This Agreement is made and entered into by:

The PHILIPPINE CHARITY SWEEPSTAKES OFFICE (PCSO), a

government owned and controlled corporation existing by virtue of
Republic Act No. 1169, as amended, holding office at 10F Sun Plaza
Building, 1507 Shaw Boulevard corner Princeton Street, Mandaluyong
City, represented by its Vice Chairperson and General Manager, ROYINA
M. GARMA, authorized for this purpose under Board Resolution No. 0234
series of 2020, a copy of which is attached as Annex “A”;

-and-

The __________________________________ (PARTNER HOSPITAL),

a government hospital under the management and administration of the
[Department of Health (DOH) / Local Government Unit (LGU) / State
University or College (SUC)], represented by [NAME OF
REPRESENTATIVE], in [his/her] capacity as [title/position], authorized for
this purpose under ______________________ dated _____ (Annex
“B”).

PCSO and PARTNER HOSPITAL are referred to collectively as the

PARTIES.

ANTECEDENTS

By virtue of Republic Act No. 1169 as amended (the PCSO Charter), PCSO is
the principal government agency to raise and provide funds for health programs, medical
assistance and services, and charities of national character.

Republic Act No. 11463 or the Malasakit Centers Act of 2019 (the MCA) and its
Implementing Rules and Regulations (MCA-IRR) (Annex “C”) mandate the
establishment of the Malasakit Program consisting of malasakit centers in Department of
Health (DOH) Hospitals, the Philippine General Hospital (PGH), and other public
hospitals such as PARTNER HOSPITAL. The malasakit centers shall, among others,
facilitate access to PCSO’s medical assistance for indigent and financially incapacitated
patients, chargeable against PCSO funds.

By virtue of Board Resolution No. __ series of ____, the PCSO Board of

Directors approved the establishment of the PCSO Desks in the malasakit centers and
adopted the “2021 Implementing Guidelines for the Malasakit Centers” (the PCSO Desk
Guidelines) to put in operation the grant of medical assistance at the PCSO Desk. A
copy of Secretary’s Certificate dated ______ is attached as Annex “D.”

By virtue of Board Resolution No. __ series of ____, the PCSO Board of

Directors approved the establishment of the PCSO Desk in the Malasakit Center of
PARTNER HOSPITAL (Annex “E”).

ACCORDINGLY, the PARTIES agree as follows:

I. OBLIGATIONS OF PARTNER HOSPITAL

PARTNER HOSPITAL shall:

1. Provide the necessary cubicles, rooms, or desks for the PCSO Desk at the
Malasakit Center within its premises, in accordance with Section 7.2.a.(v) of the
MCA-IRR.

2. Strictly implement the order of charging for the medical and financial assistance
provided to patients, in accordance with Section VI (C) of Joint Administrative
Order No. 2020-001 (the Operational Guidelines for the Implementation of the -
 Medical and Financial Assistance to Indigent and Financially Incapacitated
Patients pursuant to Republic Act No. 11463, or the MCA-JAO for brevity).

3. Honor all valid Claim Slips covering the confinement of patients and Guaranty
Letters covering outpatient treatments, issued by PCSO at the PCSO Desk
within PARTNER HOSPITAL’s premises.

4. Submit to the PCSO Point Persons at the PCSO Desk the documents required
for PCSO to process requests for medical assistance, including but not limited to:

a. The Certificate of Eligibility (COE) and Unified Intake Sheet (UIS), in the
form prescribed under Annexes “A” and “C” of the MCA-JAO;

b. The Statement of Account (SOA) for each patient;

c. The patient’s Medical Abstract with printed name, signature and license
number of the attending physician, as required in Section VI(B)(1) (PCSO
Desk) of the MCA-JAO; and

d. For outpatients, the following additional documents:

i. Treatment protocol, for chemotherapy assistance;

ii. The prescription issued by the attending physician;

iii. The official quotation of the patient’s bill; and

iv. Certification on the number of sessions availed from Philhealth,

for hemodialysis assistance.

5. Prepare the SOA and supporting documents thereto, accompanied by a

summary of all patients to whom medical assistance is given through the PCSO
Desk of PARTNER HOSPITAL for collection by duly authorized PCSO Branch
Office personnel, in the form and frequency prescribed under PCSO Guidelines.

6. Comply with the policies, procedures, and obligations under the MCA, MCA-IRR,
MCA-JAO, PCSO Guidelines, this Agreement, and issuances by the DOH,
PCSO, the Participating Agencies, or other government agencies relative to the
implementation of the Malasakit Program.

II. OBLIGATIONS OF THE PCSO

PCSO shall:

1. Provide medical assistance at the PCSO Desk pursuant to the MCA, MCA-IRR,
MCA-JAO, the PCSO Desk Guidelines and other guidelines issued by PCSO on
the grant of medical assistance (collectively the PCSO Guidelines), and this
Agreement, subject to the monthly budget allocated to PARTNER HOSPITAL.

2. Process requests for the following types of medical assistance in accordance

with PCSO Guidelines:

a. Confinement Assistance for patients currently admitted or discharged from

PARTNER HOSPITAL;

b. Chemotherapy Assistance for patients diagnosed with malignant tumor/s or

cancer requiring treatment for oral (hormonal) and intravenous
chemotherapy drugs;

c. Dialysis Assistance for patients requiring hemodialysis and Erythropoietin

injection, after the sessions granted by Philhealth;

d. Hemophilia Medicine Assistance for patients with diagnosis of Hemophilia

requiring medication;

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Memorandum of Agreement – PCSO Desk (PARTNER HOSPITAL)
 e. Post-transplant medicine assistance for patients who underwent transplant
surgery; and

f. Other types of medical assistance authorized by the PCSO Board of

Directors in accordance with its existing Medical Access Program (MAP).

3. Designate personnel who shall man the PCSO Desk as PCSO Point Persons in
accordance with the MCA, the MCA-IRR, and the MCA-JAO.

4. Ensure the timely and orderly release to the patients or their representatives of
the Claim Slip (in the case of confined patients) or Guaranty Letter (in the case of
outpatients) and the Unified Intake Sheet, in the form prescribed under the MCA-
JAO.

5. Ensure the lawful processing and confidentiality of personal information received

by PCSO in accordance with Republic Act No. 10173 (the Data Privacy Act of
2012) and related laws, rules and regulations.

6. Ensure the timely and orderly collection of documents that its Branch Office
personnel are required to collect from the PARTNER HOSPITAL in accordance
with PCSO Guidelines.

7. Provide technical assistance to ensure the successful implementation of the

Malasakit Program in accordance with Section VII (C) (6) of the MCA-JAO.

8. Comply with the policies, procedures, and obligations under the MCA, MCA-IRR,
MCA-JAO, PCSO Guidelines, this Agreement, and issuances by the DOH, the
Participating Agencies, or other government agencies relative to the
implementation of the Malasakit Program.

III. OTHER PROVISIONS

1. In the case of confined patients, all requests for medical assistance shall be filed
at the PCSO Desk prior to the patient’s discharge. In case of a patient’s death,
the request must be submitted in accordance with PCSO Guidelines.

2. When the condition of the patients renders them unable to personally file a
request for medical assistance, only their immediate family member of legal age
or authorized representative may apply for medical assistance on their behalf.

3. The processing of payments shall be supported by the documentary

requirements used in the processing of assistance together with the original
Claim Slip for confinement, the Guaranty Letter supported by the Statement of
Account and Charge Slips for other outpatient services. PCSO shall not process
payments without complete documents.

4. PCSO, its directors, officials and employees shall be free and held harmless from
and against any claim, liability, damage, penalty, judgment, suit and costs arising
from any fortuitous event or the negligence or fault of the PARTNER HOSPITAL,
its officers, employees and representatives, or of the other Participating
Agencies, their officers, employees and representatives, in connection with the
establishment and operations of the Malasakit Center within the PARTNER
HOSPITAL’s premises.

5. The PARTIES hereby agree that if either PCSO or the PARTNER HOSPITAL
fails to perform its roles, responsibilities or other obligations under the MCA,
MCA-IRR, MCA-JAO, or obligations in the PCSO Guidelines that pertain to the
foregoing laws, rules and regulations, the penal provisions in Section 11 of the
MCA as implemented by Rule VI Section 11 of the MCA-IRR, and as further
implemented by Section X of the MCA-JAO, shall apply.

6. Pursuant to Rule VI Section 11.3 of the MCA-IRR, all complaints and cases shall
be submitted to the PARTNER HOSPITAL’s complaint and grievance committee
for appropriate action. Complaints and cases directed toward PCSO shall be
handled by PCSO in accordance with its Citizen’s Charter, and shall be filed
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Memorandum of Agreement – PCSO Desk (PARTNER HOSPITAL)
 exclusively at the courts where the PCSO Head Office is located at the time of
filing.

7. All actions and controversies that may arise from this Agreement involving but
not limited to demands for the specific performance of the obligations as
specified herein and/or in the interpretation of any provisions or clauses
contained herein, shall, in the first instance, be settled within thirty (30) calendar
days through amicable means, such as, but not limited to mutual discussion.
Should the dispute remain unresolved by the end of the aforementioned period,
the dispute shall be submitted to the Office of the Secretary of Justice pursuant
to the provisions of Section 66, 67, 68, 69, 70 and 71, Chapter 14, Book IV, Title
III of the Administrative Code of 1987 (Executive Order No. 292), in relation to
Presidential Decree No. 242 (Prescribing the Procedure for the Administrative
Settlement of Claims and Controversies Between or Among Government Offices,
Agencies and Instrumentalities, including Government-Owned and Controlled
Corporations, and for Other Purposes).

8. This Agreement shall take effect upon signing by the Parties and shall be in full
force and effect unless earlier terminated, revoked or cancelled.

9. No amendment or modification to this Agreement shall be valid or binding unless

expressed in writing and executed with the same formality as this Agreement.

__________________ at __________________________, Philippines.

PARTNER HOSPITAL
PHILIPPINE CHARITY
SWEEPSTAKES OFFICE (PCSO)

By: By:

ROYINA M. GARMA [NAME OF REPRESENTATIVE]

Vice Chairperson and General Manager [title/position]

SIGNED IN THE PRESENCE OF:

____________________________ ____________________________
Witness Witness

REPUBLIC OF THE PHILIPPINES)

___________________________ ) S.S.

ACKNOWLEDGMENT

Personally appeared before me on _________________ at __________________:

Name Competent Evidence of Date & Place Issued

Identity
GM Royina M. Garma PCSO ID No. 2019-0394 July 18, 2019 / Mandaluyong City

They are known to me to be the same persons who executed the foregoing Agreement,
and who acknowledged that their signatures prove their voluntary act and of the entities
they respectively represent for the purposes stated in this document.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2021.

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Memorandum of Agreement – PCSO Desk (PARTNER HOSPITAL)