Dr. S R Manalan's Presentation

PHFSAPOST REGISTRATION CHECKLIST

PURPOSE OF INSPECTION POST REGISTRATION SURVEILLANCE ENFORCEMENT

PART 1DOCUMENTS INSPECTION

ORGANISATION & MANAGEMENT MANDATORY REQUIREMENTS OTHER REQUIREMENTS

EMERGENCY CALL INFORMATIONIn the event of emergency the relevant contact telephone numbers are : DR MMA HOSPITAL IPOH IPOH SPECIALIST HOSPITAL HOSPITAL FATIMAH HOSPITAL PANTAI PUTRI BALAI POLIS PEKAN BARU FIRE BRIGADE/BOMBA : : : : : : : 012-1234567 05-2533333 05-2418777 05-5455777 05-5484333 05-2424222 05-5499111

EMERGENCY FIRE/POLICE/AMBULANCE : 999

Ambulance may be called from Hospital Ipoh/Ipoh Specialist Hospital or any of the other hospital listed above.

ORGANISATION CHARTPerson In Charge (PIC) DR MMA

Administrator PN SITI

Accounts MS LIM

Clinic Nurse MS CATHERINE

Clinic Nurse MS PAULINE

Clinic Nurse CIK IDA

Clinic Nurse

Clinic Nurse

CIK NOR

MS JENNY

Janitor

PN YATI

DUTY ROSTERDoctor : Dr MMA is the ONLY doctor available at this clinic. He will be on call every day at the clinic operating hours, EXCEPT when he is called away for Emergency (House-Calls)

Clinic Nurses :

All the nurses (Ms Catherine, Ms Pauline, Cik Ida, Cik Nor and Ms Jenny) will be on call at the clinic during the clinic operating hours.

STAFF REGISTERNAME Dr MMA Ms Lim Pn Siti Ms Catherine Cik Ida Cik Nor I/C NO 000120-8-5530 TEL NO 012-1234567 ADDRESS 723 Jln Bintang Taman KL 50 Laluan Bendahara KL 14 Lebuh 5 Tmn Bintang 4 KL 32 Jalan Tasek Klang 54 Tmn Tasek Kl 10 Jln 11 Tmn Orkid KL

123500-08-7750 012-0012345 012300-08-5520 012-1230000 001133-03-2230 012-3044500 220000-01-1234 012-5400600 001130-01-3200 012-1230040

STAFF REGISTERNAME I/C NO TEL NO ADDRESS

Ms Jenny

213000-01-4500

012-3006000

21 Jln Tasek 4 KL

Pn Yati

450100-01-7800

012-6005050

123 Jln Kuala Ipoh

POLICY & PROCEDURE MANDATORY REQUIREMENTS OTHER REQUIREMENTS

CLINIC POLICYOrganisation : Klinik MMA 546-548 Jalan Bintang Taman Orkid 45300 Kuala Lumpur The Resident Doctor is DR MMA MBBS (Malaya) He provides consultation, diagnostic and treatment services as well as medical advice to patients.

Resident Doctor

:

CLINIC POLICYResponsibilities of the Doctors : The doctor in charge is responsible for the overall management of the patients. He is responsible for the initiation of treatment of the patient, including the administration of injections. He will supervise the dispensation of pharmaceutical drugs.

CLINIC POLICYServices provided : Only outpatient treatment and services are provided. Patients are seen on a first come first serve basis. Diagnostic and Imaging services provide : Urine pregnancy test Abdominal/pelvic ultrasound Blood screening tests

PROCEDURE OF PATIENTS REGISTRATION, ATTENDANCE AND REFERRALSRegistration/Attendance : All patients must be registered in the attendance sheet. The following details have to be entered into each patients treatment card : Name Sex Address Identity Card No. Contact Tel. No/s if available

KLINIK MMA Registration SheetNO PATIENTS NAME I/C NO ADDRESS

FOLLOW UP PATIENT REGISTERDATE REG NO NAME I/C NO SIGN

REFERRALS Patients will be referred to a doctor or hospital of his/her choice. Patients who have to be referred to a hospital for any acute illness or emergency are advised to go to a hospital using their own transport as this will be faster. However, upon request, or if the need arises, an ambulance can be arranged from Hospital Ipoh or Ipoh Specialist Hospital. Every effort will be made to inform the doctor on call at the hospital to which the referral is being made. Patients with unstable vital signs will be given all appropriate treatment possible and will be transferred to the hospital of their choice by ambulance.

REFERRAL FORMKLINIK MMA DR. MMA MBBS (Malaya) 546-548 Jalan Bintang Taman Orkid 45300 Kuala Lumpur Tel no: 03-66053210 Fax no: 03-66545460

PLEASE BILL CLINIC / PATIENT / COMPANYDate : To: ..

C No: 6011

Dear Dr. RE I/C No: AGE:.SEX: COMPANY:..

I wish to refer this patient to your. Patients complaint / history : ..... Thank you. Yours faithfully,

.

INCIDENT REPORTING A report of an adverse event, e.g. death

happening in the clinic. The person in charge to document all details of incident including reporting the event.

INCIDENT REPORT FORM Name of Clinic : ______________________________ Address of Clinic : ______________________________ Date and Time of Incident : ___________________________ Nature of Incident : __________________________________ __________________________________ __________________________________ Action : __________________________________ __________________________________ Date of Report Sent : _________________________________ Name of Person Pending Report : ______________________

INFECTION CONTROL All notifiable diseases are to be recorded in a Notifiable Infection Disease Register. All notifiable diseases shall be reported to the relevant authorities in the infectious disease notification form.

GENERAL PROVISIONS FOR STANDARDS OF PMC OR PDC

STANDARDS FOR OUTPATIENT FACILITIES AND SERVICES

TRANSPORTATION OF LABORATORY SPECIMEN : All specimens are to be collected in the respective containers supplied by the laboratory. The collected specimens must be properly labeled. All specimens are to be collected/sent to the laboratories in bag. plastic

All specimens must be accompanied with a duly filled request form. All specimen are to be sent to the laboratories soon after collection.

All records of dispatch of specimen to be properly recorded and maintained

FEE SCHEDULE A copy of the Fee schedul e is ke pt in the clini c for the pati ents ref erence

Klinik MMA 546-548 Jalan Bintang Taman Orkid 45300 Kuala LumpurCONSE NT F OR M F OR OPE R AT I ON / PR OCE D UR EI...NRIC.Residing at ..at present, a patient in Klinik Manalan (M)

Sdn. Bhd. , No. 723-725, Jalan Kuala Kangsar, Ipoh, hereby authorise Dr...... (and whomever he may designate as his assistant) to perform ....... and such additional procedures and operations as are considered necessary on the basis of findings during the course of the above mentioned operation / procedure. I further hereby give consent to the administration of Anesthesia as may be deemed necessary for the performance of the above mention operation / procedure. I hereby certify that, I have been fully explained, the nature of the operation / procedure in my OWN LANGUAGE and fully understand the above authorization.

.. Signature of Patient Date :.

. Signature of Witness Date :

Signature of Doctor Date :..

PATIENT GRIEVANCE MECHANISM PLAN :Mechanism : Any patient with a grievance will be advised to discuss his grievance with the doctor. If after this, and the grievance still remains unresolved, the patient is then requested to lodge his grievance by filling the Grievance Report Form which should be acknowledged by the doctor. An investigation is then conducted as soon as possible and the findings are to be recorded in the Grievance Investigation Report Form. The complainant is then informed of the outcome of the investigation. If this fails to resolve the matter, the doctor shall arrange a mediator who is agreeable to both parties. If this fails too, then the matter is referred to the Director General for adjudication.

GRIEVANCE REPORT FORMName of Patient : I.C. No : Date : Nature of Grievance : ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________

Received by (staff)

:

GRIEVANCE INVESTIGATION REPORT FORMClinic : Address : Name of Patient : I.C. No : Date : Nature of Grievance : ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Findings of Investigation : ______________________________ ______________________________ ______________________________ Result : ______________________________ ______________________________

PROVISION OF MEDICAL REPORTS Upon a wr itten request by a pati ent , the cl ini c wi ll issue a medi cal report. A pay ment may be requi red to prepar e the sai d medical repor t

DISASTER PREPAREDNESS PLAN In the event of a di saster occurri ng in the cl ini c or in the vici ni ty of the cl ini c, a disaster acti on pl an wi ll be acti vated : - An area in the clinic will be prepar ed receive d the patient s - Basic f irst aid will be provided immedi at ely - Basic emerg ency car e equipme nt wil l mobilised to t his ar ea - The near est hospital is to be inf ormed pr epare the a rrival of t he patient s. - App ropriat e recor d of the referr ed pati en ts be kept to

be to to

STAFF IDENTIFICATION ALL Cl inic Staf f wi ll wear identi ficati on na met ags duri ng cli ni c hours

BILLING PROCEDURE The medi cal bi ll and itemi zed recei pt is to be gi ven to the pati ent, if requested

INFECTION CONTROL MANDATORY REQUIREMENTS OTHER REQUIREMENTS

SPECIAL REQUIREMENTS FOR EMERGENCY CARE SERVICES MANDATORY REQUIREMENTS OTHER REQUIREMENTS

PART IIFACILITIES AND SERVICES INSPECTION

COLD CHAIN MAINTENANCE Dedicate this refrigerator only for storing vaccines Do not store drugs, specimens, reagents, food or drinks in this refrigerator Locate your refrigerator appropriately Place your vaccine in the appropriate area Do not store vaccine in door shelves or freezer, or in the compartment directly under the freezer. Place thermometer in centre of refrigerator, so that it can be read without moving the thermometer.

COLD CHAIN MAINTENANCE Maintain refrigerator temperature at 2C to 8C the time Do not open the refrigerator unnecessarily. If your refrigerator requires defrosting, do it at least monthly. Have an action plan in the event of power failure.

COLD CHAIN MAINTENANCE* Monitor the refrigerator temperature daily Use dial or minimax thermometers Chart the refrigerator temperature at least once every working day. If temperature is persistently below 2C to 8C : i) check refrigerator regulator ii) set regulator higher if above 8C iii) set regulator lower if below 2C iv) if this does not work, defrost your refrigerator

SPECIAL REQUIREMENTS FOR PHARMACEUTICAL SERVICES MANDATORY REQUIREMENTS OTHER REQUIREMENTS

SPECIAL REQUIREMENTS FOR RADIOLOGICAL OR DIAGNOSTIC IMAGING SERVICES MANDATORY REQUIREMENTS OTHER REQUIREMENTS

LEVEL OF COMPLIANCE MORE OR EQUIVALENT TO 75% - SAFE 50 - 74% - WARNING WITH 3 MONTHS PERIOD OF RECTIFICATION < 50% - PENDING REVOKE COR (RECOMMEND TO MOH & AWAITING DGS DIRECTIVES)