Republic of the Philippines Department of Health SAN LAZARO HOSPITAL Manila… · 2020. 7. 24. · Hospitals and Charity Clinics Classifying Patients According to Their Financial

Republic of the Philippines

Department of Health

SAN LAZARO HOSPITAL Manila, Philippines

Telephone Nos.: 8732-3776 to 78; 8732-3106 E-mail Address: [email protected]

Official Website: www.slh.doh.gov.ph

Kanlungan ng maysakit… Serbisyong may puso…

ADMINISTRATIVE ORDER NO. 23 COMPLIANCE REPORT TEMPLATE

(1) NAME OF DEPARTMENT/AGENCY/LGU: SAN LAZARO HOSPITAL/FINANCE MANAGEMENT

DIVISION/ BILLING AND CLAIMS DEPARTMENT

(2) SUBMITTED UPDATED CITIZEN’S CHARTER TO ARTA ON JULY 25, 2020: [ X ] Yes [ ] No

(3) LIST OF ALL FRONTLINE SERVICES AND CORRESPONDING LEGAL BASIS

GOVERNMENT

SERVICE

LEGAL BASIS OFFICE/AGENCY REGULATIONS

Governing

Law(s)

(Number and

Short Title)1

Specific

Provision in

the

Governing

Law(s) as

Basis2

Issuance/Policy

Title

Date of

Effectivity

Other Issuances/Policies

it Effectively

Repeals/Amends

PROCESSING

OF HOSPITAL

BILL AND

ISSUANCE OF

STATEMENT

OF ACCOUNT

FOR

ADMITTED

PATIENTS

EO 292 –

Instituting the

“Administrative

Code of 1987”

Book V –

Office of the

President

Title 1-

Constitutional

Commissions

Subtitle B –

The

Commission

on Audit

Chapter 7–

Receipt and

Disposition of

Funds and

Property

Section 44

SLH Billing and

Claims Unit

Operational

Manual

2018 None

1 Number and short title of the governing law which mandates and gives power to the agency or LGU to regulate and/or offer the service 2 Cite section number and quote provision identified in the governing law







(4) SERVICE INFORMATION PER GOVERNMENT SERVICE3

GOVERNMENT SERVICE: PROCESSING OF HOSPITAL BILL AND ISSUANCE OF STATEMENT OF ACCOUNT FOR

ADMITTED PATIENTS

SERVICE INFORMATION Processing of charges from all cost centers (Pharmacy, Laboratory, Radiology, CSSU,

RTU, Clinical Wards & Special Areas), Philhealth benefits availment and other entitlements (Medical Assistance)

including Quantified Fee Service (QFS). Service open Monday to Friday 8am to 5:00pm.

LIST OF REQUIREMENTS LIST OF STEPS AND PROCEDURES

Requirement Legal Basis Client

Steps/Procedures as

indicated in the

Citizen’s Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

1. MGH

Notice/Discharge

Notice and

Clearance

2. Duly signed claim

Signature Form

(CSF) (Part 1 IV)

3. Duly signed

Philhealth Claim

Form 2

4. Accomplished

Philhealth

Member

Registration

Form (PMRF)

SLH Billing

and Claims

Unit

Operational

Manual

Present MGH Notice/

Discharge Notice and

Clearance &

Documentary

requirements for

billing

EO 292 –

Instituting the

“Administrative

Code of 1987” -

Chapter 7,

Section 44

38

minutes

None

Waits while

Philhealth benefits

availments is being

processed

None







Signs Final SOA with

benefit availment

and Part III of Claim

Form

30

minutes

None

Present the tentative

SOA

None

Returns to Billing and

Claims Dept. and

submits Final SOA

with medical

assistance availment

or Official Receipt

15

minutes

Signs the Certificate

of Benefits Availment

& SOA and secures

copy of same

1 minute

TOTAL

1 Hour &

24

Minutes








(1) NAME OF DEPARTMENT/AGENCY/LGU: SAN LAZARO HOSPITAL HOSPITAL / ALLIED MEDICAL DIVISION / CENTRAL LABORATORY DEPARTMENT



GOVERNMENT SERVICE


Governing Law(s)

(Number and Short Title)4

Specific Provision in

the Governing Law(s) as

Basis5

Issuance/Policy Title

Date of Effectivity

Other Issuances/Policies it Effectively

Repeals/Amends

EXAMINATIONS LABORATORY

(OUT-PATIENTS AND IN-

PATIENTS)

Republic Act 4688s.1966, An Act regulating the Operation & Maintenance of Clinical Laboratories

Section 1, Any person, firm or corporation, maintaining a clinical laboratory shall register and secure a license annually, at the office of the Secretary of Health

Administrative Order no 2007-0027 Revised Rules and Regulations Governing The Licensure & Regulation of Clinical Laboratory in the Philippines.

August 22, 2007

Administrative Order No. 59s. 2001 Rules and Regulations Governing the Establishment, Operation and Maintenance of Clinical Laboratories in the Philippines









GOVERNMENT SERVICE: EXAMINATIONS LABORATORY (OUT-PATIENTS AND IN-PATIENTS)

SERVICE INFORMATION


Requirement Legal Basis Client Steps/Procedures as indicated in the Citizen’s

Charter

Legal Basis Total Processing

Time

Total Fees to be Paid

1. Completely filled-out Laboratory Request Form 2. Hospital ID Card (for Out-Patients only)

SLH Central Laboratory Operational

Manual

Present completely filled-out request form

SLH Central Laboratory

Department Operational

Manual

Routine: 6 hours and 44 minutes

Stat: 1

Hour and 44 Minutes

None

Republic Act No. 747

entitled “An Act to Regulate the Fees to be

Charged Against

Patients in Government Hospitals and Charity Clinics

Classifying Patients

According to Their Financial

Condition”

Refer to the pricelists

below

6 Please note that one table is to be fi l led-up per Government Service. To fi l l up:

a) List down all requirements applicable to the government service b) Per requirement, cite legal basis/rationale why requirement is essential c) Steps/Procedures should be listed in the Client's perspective d) If applicable, legal basis of each step/procedure may be indicated in column 4 e) Input the total processing time for the service in working days and/or hours f) Input the sum of all fees paid for the service







Proceed to Extraction Room SLH Central Laboratory

Department Operational

Manual

None

Claiming of result None

TOTAL 17 Minutes

PRICELIST OF LABORATORY SERVICES








(1) NAME OF DEPARTMENT/AGENCY/LGU: SAN LAZARO HOSPITAL / MEDICAL DIVISION /

EMERGENCY MEDICAL DEPARTMENT

(2) SUBMITTED UPDATED CITIZEN’S CHARTER TO ARTA ON JULY 25, 2020: [ X ] Yes [ ]

No


GOVERNMENT

SERVICE


Governing Law(s)

(Number and

Short Title)7

Specific

Provision in the

Governing

Law(s) as Basis8

Issuance/Policy

Title

Date of

Effectivity

Other

Issuances/Policies

it Effectively

Repeals/Amends

Admission of

patients

Republic act 8344

An act penalizing

the refusal of

hospitals and

medical clinics to

administer

appropriate

initial medical

treatment and

support in

emergency or

serious cases,

amending for the

purpose batas

pambansa bilang

702, otherwise

known as "an act

prohibiting the

demand of

deposits or

advance

payments for the

confinement or

Section 1 and

Section 2

SLH Emergency

Management

Department

Operational

Manual

2018 None

Consultation of

patients








treatment of

patients in

hospitals and

medical clinics in

certain cases.

Admission of

Suspect/COVID-

19 Patients

ADMINISTRATIVE

ORDER 2020-

0016-Minimum

health system

capacity

standards for

COVID 19

Preparedness

and Response

Strategies

A. Effective

whole-of-

government

and whole-of-

society action

against the

COVID-19

threat requires

a national

government-

enabled, local

government-

led and people-

centered

response,

aligned with

the principles

of universal

health care.

National

government

agencies, local

government

units, and DOH

CHDs, and the

private sector

shall work

together to

rapidly expand

health system

capacity and

provide

mechanisms for

sharing of

None None None







resources, as

necessary

D. All actors

shall endeavour

to achieve the

minimum

health system

capacity targets

to ensure that

all persons

classified as

suspect,

probable and

confirmed

COVID-19 cases

and close

contacts are

detected,

isolated, and

treated.








GOVERNMENT SERVICE: Admission of Suspect/COVID-19 Patients

SERVICE INFORMATION: Process in admitting patient to specific areas


Requirement Legal Basis Client Steps/Procedures as

indicated in the Citizen’s

Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1. Patient

Information

Slip (PIS)

2. ER Patient

Record

3. Clinical Case

Record

4. Admission

Chart

SLH

Emergency

Management

Department

Manual of

Operations

1. Patient submit

himself/herself for

assessment at triage area

SLH Emergency

Management

Department

Operational

Manual

50 minutes

None

2. Fill up patient’s information

slip

None

3. Patient submit

himself/herself for physical

examination, evaluation and

admission

None

TOTAL 50 minutes None








GOVERNMENT SERVICE: CONSULTATION for Suspect/COVID-19 Patients

SERVICE INFORMATION: Process in the consultation patient.




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1. Patient

information slip

(PIS)

2. ER Patient

Record

3. Charge Slip

4. Medical Record

5. Request Form

6. Xray Request

Form

SLH

Emergency

Management

Department

Manual of

Operations

1.Patient submit

himself/herself for


SLH

Emergency

Management

Department

Manual of

Operations

5 minutes

None

2.Fill up information slip 10 minutes None

3.Pay the registration fee and

secure admission number

15 minutes P50.00

4.Patient submit himself/

herself for physical

examination and evaluation

60 minutes


herself for diagnostic

procedure

10 minutes

TOTAL 1 hour & 30

minutes

P50.00








GOVERNMENT SERVICE: Admission of patients

SERVICE INFORMATION: Process in admitting patient to specific areas




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1. Patient

information slip

(PIS)

2. ER Patient

Record

3. Charge Slip

4. Patient Medical

Record

SLH

Emergency

Management

Department

Manual of

Operations

1.Patient submit

himself/herself for


SLH Emergency

Management

Department

Operational

Manual

5 minutes

None




15 minutes P50.00




60 minutes

5.Secure clinical case record

at central admitting section

10 minutes

6.Submit the clinical case

record

21 minutes

TOTAL 2 hours & 1

minute

None








GOVERNMENT SERVICE: Consultation of patients

SERVICE INFORMATION: Process in the consultation of patients




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1. Patient

information slip

(PIS)

2. ER Patient

Record

3. Charge Slip

4. Patient Medical

Record

5. Laboratory

Request Form

6. Xray Request

Form

SLH

Emergency

Management

Department

Manual of

Operations

1.Patient submit

himself/herself for


SLH Emergency

Management

Department

Operational

Manual

5 minutes

None




15 minutes P50.00




60 minutes


herself for diagnostic

procedure

10 minutes

TOTAL 1 hour & 30

minutes

P50.00








(1) NAME OF DEPARTMENT/AGENCY/LGU: SAN LAZARO HOSPITAL HOSPITAL / ALLIED MEDICAL

DIVISION/ HOSPITAL INFORMATION AND MANAGEMENT DEPARTMENT


No


GOVERNMENT

SERVICE


Governing

Law(s)

(Number and

Short Title)13

Specific

Provision in

the

Governing

Law(s) as

Basis14

Issuance/Policy

Title

Date of

Effectivity


it Effectively

Repeals/Amends

REQUISITION

OF OPD

MEDICAL

CERTIFICATE

DOH Hospital

Health

Information

Management

Manual, 3rd.

Edition 2010

Chapter 4-

Systems and

Procedures,

Page 91

SLH HIMD

Operational

Manual

2018 None









GOVERNMENT SERVICE: REQUISITION OF OPD MEDICAL CERTIFICATE

SERVICE INFORMATION: Issuance of requested Medical Certificate to Animal Bite and Medical patients




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1 Original copy

1. Rabies Post

Exposure

Prophylaxis

Card

2. Patient's

Hospital ID

3. Charge Slip

SLH HIMD

Operational

Manual

1. Submits Properly Filled-

out Rabies Post Exposure

Prophylaxis Card for Animal

Bite Patients and Patient's

Information Slip for Medical

Patients

SLH HIMD

Operational

Manual

30 minutes

None

2.Pay at the Cashier Office EO 292 –

Instituting the

“Administrative

Code of 1987”

P130.00

3. Waits while Medical

Certificate is being processed

SLH HIMD

Operational

Manual

None

TOTAL 30 minutes 100.00








GOVERNMENT SERVICE: REQUISITION OF ER/ OUT PATIENT RECORD OF OLD PATIENTS

SERVICE INFORMATION: The Admitting / Information is charged in the issuance of patients blottersheet thru

homis system. The Admitting / Information is open 24 hours with no noon break.




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1 original copy

1. Patient

Information Sheet

2. Charge Slip

SLH HIMD

Operational

Manual

1. Submit properly fill-out

Patients Information Sheet

SLH HIMD

Operational

Manual

1 minute

None

2. Pay at the cashier EO 292 –

Instituting the

“Administrative

Code of 1987”

1 minute P20.00

3. Update patients record SLH HIMD

Operational

Manual

10 minutes None

4. Issue print-out of ER/ Out

Patient Record

SLH HIMD

Operational

Manual

3 minutes None

TOTAL 15 minutes P20.00








GOVERNMENT SERVICE: ISSUANCE OF ER/ OUT PATIENT RECORD AND HOSPITAL ID FOR NEW PATIENT

SERVICE INFORMATION The Admitting / Information is charged in the issuance of patients blottersheet and

Hospital ID thru homis system. The Admitting / Information is open 24 hours with no noon break




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1 original copy

1. Patient

Information Sheet

2. Charge Slip

SLH HIMD

Operational

Manual



SLH HIMD

Operational

Manual

1 minute

None

2. Pay at the cashier

EO 292 –

Instituting the

“Administrative

Code of 1987”

1 minute P50.00

3. Encode patient's information

SLH HIMD

Operational

Manual

10 minutes

4. Issue print-out of ER/ Out

Patient Record and Hospital ID

3 minutes









GOVERNMENT SERVICE: REQUISITION OF ANIMAL AND HUMAN BITE DATA SHEET AND POST EXPOSURE

PROPHYLAXIS CARD

SERVICE INFORMATION The Admitting / Information is charged in the issuance of patients Animal and Human

Bite Sheet and Post Exposure Prophylaxis Card thru homis system. The Admitting / Information is open every

Monday to Friday after 3pm cut-off and Every Saturday after 11am cut-off of OPD Animal Bite Center; while

during every Sunday and Holidays is open 24 hours with no noon break




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1. Patient

Information Sheet

2. Charge Slip

SLH HIMD

Operational

Manual



SLH HIMD

Operational

Manual

1 minute

None


Instituting the

“Administrative

Code of 1987”

1 minute P50.00

3. Encode patient's information

SLH HIMD

Operational

Manual

10 minutes

4. Issue print-out of Animal

and Human Bite Data Sheet

and Post Exposure Prophylaxis

Card

3 minutes









GOVERNMENT SERVICE: PROCESSING OF BIRTH CERTIFICATE

SERVICE INFORMATION Processing of Birth Certificates for admitted patients




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1 original Form

Charge Slip

Birth Certificate (

preform and Official

form)

Present original copy

and 1 photocopy

1. Married

parents- PSA

Marriage

Contract

2. ID's of both

parents

3. Not married-

ID's of both

parents

4. notarized

ASUF(

Affidavit to

use the

surname of

SLH HIMD

Operational

Manual

1. Fill out preform of Birth

Certificate

SLH HIMD

Operational

Manual

5 minutes

None

2. Approaches the window

when called and presents

required documents

25 minutes None

3. Pay at the Cashier EO 292 –

Instituting the

“Administrative

Code of 1987”

5 minutes P150.00

4. Sign the Birth Certificate

> Married parents - ONLY the

mother will sign

> Not married- BOTH parents will sign

SLH HIMD

Operational

Manual

5 minutes None

5. Sign in the logbook 5 minutes None







the father),

5. CEDULA(

Community

Tax

Certificate)

6. Minor

(MOTHER) -

ID's of both

parents,

grandmother

(mother's

side),

Grandmother

shall furnish

consent

letter for her

daughter.









GOVERNMENT SERVICE: PROCESSING OF DEATH CERTIFICATE

SERVICE INFORMATION Processing of Death Certificates for admitted and ER patients




Charter

Legal Basis Total

Processing

Time

Total

Fees

to be

Paid

Original forms

1. Discharge Slip

2. Death

Certificate (

preform and

Official form)

Present Original

3. ID of the

immediate

family

Notarized

Authorization letter

(if representative of

the immediate

family)

SLH HIMD

Operational

Manual

1. Fill out preform of Death

Certificate

SLH HIMD

Operational

Manual

2 minutes

None



required documents(ID's,

Notarized authorization letter

)

12 minutes None

3. Settle the final bill and

Secure Discharge Slip from billing department

EO 292 –

Instituting the

“Administrative

Code of 1987”

1 minute None

4. Waits for the release of the

Death Certificate

SLH HIMD

Operational

Manual

25 minutes

None

4. Waits for the release of the

Death Certificate

5 minutes None









GOVERNMENT SERVICE: ISSUANCE OF MEDICAL/CONFINEMENT CERTIFICATES AND OTHER ANCILLARY

DOCUMENTS PROCESSING AND ISSUANCE OF CERTIFICATES for Admitted Patients

SERVICE INFORMATION Processing and Issuance of Medical/ Confinement Certificates and other Ancillary

Documents (Clinical Abstract and Diagnostic and Laboratory Results)




Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

1. Request Form

2. Charge Slip Form

3. Medical

Certificate,

Certificate of

Confinement, and

other Ancillary

documents

SLH HIMD

Operational

Manual

1. Fill out request form SLH HIMD

Operational

Manual

2 minutes

None

2. Waits for the availability

of Patient Health Record

10

minutes

None


Instituting the

“Administrative

Code of 1987”

6 minute P130.00

Medical and

Confinement

Certificate

P150.00

Clinical

Abstract

P100.00 for

laboratory

results



required documents(ID's,

Authorization letter, Letter

of consent (SPECIAL

CONCERN)

SLH HIMD

Operational

Manual

10

minutes

None

5. Sign in the logbook 2 minutes None







TOTAL

30

minutes

P130.00

Medical and

Confinement

Certificate

P150.00

Clinical

Abstract

P100.00 for

laboratory

results








(1) NAME OF DEPARTMENT/AGENCY/LGU: SAN LAZARO HOSPITAL / HOPSS / HUMAN RESOURCE

MANAGEMENT DEPARTMENT


No


GOVERNMENT

SERVICE


Governing

Law(s)

(Number and

Short Title)22

Specific

Provision in

the

Governing

Law(s) as

Basis23

Issuance/Policy

Title

Date of

Effectivity


it Effectively

Repeals/Amends

SUBMISSION

AND

ACCEPTANCE

OF

EMPLOYMENT/

PROMOTION

Order No. 292

– Instituting

the

“Administrative

Code of 1987”

Book V –

Chapter 5:

Personnel

Policies and

Standards

Section 21:

Recruitment

and Selection

of Employees

An

opportunity

for gov’t

employment

shall be

opened to all

qualified

citizens and

positive

efforts shall

be exerted to

attract the

SLH Human

Resource

Management

Office

Operational

Manual

2018 None








best qualified

to enter the

service.








GOVERNMENT SERVICE: SUBMISSION AND ACCEPTANCE OF EMPLOYMENT/ PROMOTION APPLICATION

SERVICE INFORMATION HRMD is responsible for recruiting, screening, interviewing and placing workers.

It also handles employee relations, payroll and benefits. Open from Monday to Friday 8:00am-5:00pm.

LIST OF REQUIREMENTS LIST OF STEPS AND

PROCEDURES

Requirement Legal Basis Client

Steps/Procedures

as indicated in

the Citizen’s

Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

Must submit the complete

documents:

1 copy each

1. Application letter addressed

to the

Medical Center Chief II

2. Personal Data Sheet Form (CS

Form 212, Revised 2017)

3. Work Experience Sheet (CS

Form 112)

4. Photocopy of Authenticated

Transcript of Records/ Form 137


Diploma

6. Photocopy of Relevant

Trainings/Seminars/Convention

s Attended


SLH Human

Resource

Management

Department

Operational

Manual

1. Applicant shall

submit the

complete

documents to the

HRMD staff in-

charge in the

Office window

SLH Human

Resource

Management

Department

Operational

Manual

5 minutes

None

2017 Omnibus

Rules on

Appointments

and other

Human

Resource

Actions

(Revised July

2018) : Rule

II.Requirements

for Regular

Appointments







PRC ID (if applicable)


PRC Board Rating (if applicable)


PRC Board Certificate (if

applicable)


Civil Service Eligibility Certificate

(if applicable)

Sub-Professional/Professional/

MC No. 11

11. Certificate of Employement

from previous employer

12. Photocopy of PSA Birth

Certificate

13. Photocopy of NBI Clearance

For Medical Doctors

14. Photocopy of Certified True

Copy of Residency Training

Certificate

15. Photocopy of Certified True

Copy of Fellowship/ Diplomate

Certificate

Applicants from/ with

previous/ current Government

Agency

16. Performance Evaluation

(with a minimum rating of VS)

17. Photocopy of Service Record

18. Photocopy of Approved

Clearance









(5) NAME OF DEPARTMENT/AGENCY/LGU: SAN LAZARO HOSPITAL / MEDICAL DIVISION/ FAMILY

MEDICINE


No


GOVERNMENT

SERVICE


Governing

Law(s)

(Number and

Short Title)25

Specific

Provision in

the

Governing

Law(s) as

Basis26

Issuance/Policy

Title

Date of

Effectivity


it Effectively

Repeals/Amends

ANTI-RABIES

CONSULTATION

FOR NEW

PATIENT

Republic act

8344

An act

penalizing the

refusal of

hospitals and

medical clinics

to administer

appropriate

initial medical

treatment and

support in

emergency or

serious cases,

amending for

the purpose

batas

pambansa

bilang 702,

otherwise

Section 1 &

Section 2

SLH Family

Medicine

Operational

Manual

2018 None








known as "an

act prohibiting

the demand of

deposits or

advance

payments for

the

confinement

or treatment

of patients in

hospitals and

medical clinics

in certain

cases.








GOVERNMENT SERVICE: ANTI-RABIES CONSULTATION FOR NEW PATIENT

SERVICE INFORMATION: Out-Patient Department (OPD) provides consultation of patients with animal-bite

concerns. Consultation time is open from Mondays to Fridays: 7AM to 5PM (4PM cut-off time) and Saturdays:

8AM to 12 Noon (11AM cut-off time)




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

Original Form

1. Pre-/Post

exposure

Prophylaxis

Card

2. Blotter

sheet

SLH Family

Medicine

Operational

Manual

Patient will Proceed to the

Consultation Area

SLH Family

Medicine

Operational

Manual

15 minutes None

Patient will return to the

doctor after 30 minutes

10 minutes None









GOVERNMENT SERVICE: ANTI-RABIES CONSULTATION FOR FOLLOW-UP PATIENT

SERVICE INFORMATION: Out-Patient Department (OPD) provides consultation of patients with animal-bite

concerns. Consultation time is open from Mondays to Fridays: 7AM to 5PM (4PM cut-off time) and Saturdays:

8AM to 12 Noon (11AM cut-off time)




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

Original Form

1. Pre-/Post

exposure

Prophylaxis

Card

2. Blotter

sheet

SLH Family

Medicine

Operational

Manual

Patient will Proceed to the

Consultation Area

SLH Family

Medicine

Operational

Manual

15 minutes

None









(1) NAME OF DEPARTMENT/AGENCY/LGU: SAN LAZARO HOSPITAL/ ALLIED MEDICAL DIVISION /

MEDICAL SOCIAL SERVICE


No


GOVERNMENT

SERVICE


Governing

Law(s)

(Number and

Short Title)29

Specific

Provision in

the

Governing

Law(s) as

Basis30

Issuance/Policy

Title

Date of

Effectivity


it Effectively

Repeals/Amends

AVAILMENT

OF MEDICAL

ASSISTANCE

Republic Act

No. 747

entitled “An

Act to Regulate

the Fees to be

Charged

Against

Patients in

Government

Hospitals and

Charity Clinics

Classifying

Patients

According to

Their Financial

Condition”

Section 1. For

purposes of

classifying

patients in

Government

Hospitals

and/or

Charity Clinics

Administrative

Order No.

2015-0031:

Amended

Guidelines for

the

Implementation

of RA 747

July 20,

2015

Administrative Order No.

2015- 0031 “Amended

Guidelines for The

Implementation of RA

747 entitled “ An Act to

Regulate the Fees to be

Charged Against Patients

In Government Hospitals

and Charity Clinics

Classifying Patients

According to Their

Financial Condition”

PhilHealth Circular No.

2017-0011, Guidelines

on the Point-of-Service

(POS) sec. IV

Participation of Health

Care Facilities, No. 5,

Ensure the Availability f

Personnel e.g. Medical








Social Welfare Officer/

Social Welfare &

Development Officer ,

trained by the

Department of Health on

the Administration of

the DOH Means Testing

.

.








GOVERNMENT SERVICE: AVAILMENT OF MEDICAL ASSISTANCE

SERVICE INFORMATION Processing of referral of medical assistance thru Medical Assistance Program for

Indigent Patient (Pharmacy, Laboratory, Radiology, CSSU, RTU, Clinical Wards & Special Areas), Philhealth

benefit availment and other entitlements (medical assistance) Including Quantified Free Service (QFS)




Charter

Legal Basis Total

Processing

Time

Total

Fees

to be

Paid

1. Referral Slip

2. Barangay

Indigency

3. Clinical

Abstract

4. Request

5.

Acknowledgement

Receipt

Republic Act

No. 747

entitled “An Act

to Regulate The

Fees to be

Charged

Against Patients

in Government

Hospitals and

Charity Clinics

Classifying

Patients

According to

Their Financial

Condition

Administrative

Order No.

2015-0031

1. Presents required

requirements to the Medical

Social Service Department

Office.

SLH MSS

Operational

Manual

5 minutes

None







Administrative

Order No.

2017-0003

“Guidelines for

the

Implementation

of the 2017

Medical

Assistance

Program (MAP)

in DOH

Hospitals and

other Selected

Government

Health Facilities

Administrative

Order No. 2017-

0003

“Guidelines for

the

Implementation

of the 2017

Medical

Assistance

Program (MAP)

in DOH

Hospitals and

other Selected

Government

Health Facilities

2. Received

Acknowledgement Receipt for

Patient's signature and

Conformed by the Nurse on

Duty.

15 minutes None

3. Received required

documents for submission to

the respective concern offices

for assistance.

5 minutes None









(10) NAME OF DEPARTMENT/AGENCY/LGU: SAN LAZARO HOSPITAL / NURSING DIVISION/ OU-

PATIENT DEPARTMENT

(11) SUBMITTED UPDATED CITIZEN’S CHARTER TO ARTA ON JULY 25, 2020 [ X ] Yes [ ] No


GOVERNMENT

SERVICE


Governing

Law(s)

(Number and

Short Title)32

Specific

Provision in

the

Governing

Law(s) as

Basis33

Issuance/Policy

Title

Date of

Effectivity


it Effectively

Repeals/Amends

ANTI-RABIES

VACCINATION

FOR FOLLOW-

UP PATIENT

Republic act

8344

An act

penalizing the

refusal of

hospitals and

medical clinics

to administer

appropriate

initial medical

treatment and

support in

emergency or

serious cases,

amending for

the purpose

batas

pambansa

bilang 702,

otherwise

known as "an

act prohibiting

Section 1 &

Section 2

SLH OPD

Operational

Manual

2018 None








the demand of

deposits or

advance

payments for

the

confinement or

treatment of

patients in

hospitals and

medical clinics

in certain

cases.









GOVERNMENT SERVICE: ANTI-RABIES VACCINATION FOR FOLLOW-UP PATIENT

SERVICE INFORMATION: Out-Patient Department (OPD) caters vaccination of patients with animal-bite

concerns referred by Family Medicine Doctors (FAMED). Vaccination time is open from Monday to Saturday.




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1. Pre-/Post

exposure

Prophylaxis Card

2. Blotter Sheet

SLH OPD

Operational

Manual

1. Patient will Proceed to

Nursing Assessment SLH OPD

Operational

Manual

5 minutes None

2. Patient will proceed to

Vaccination Area

10 minutes None









GOVERNMENT SERVICE: ANTI-RABIES VACCINATION FOR NEW PATIENT

SERVICE INFORMATION: Out-Patient Department (OPD) caters vaccination of patients with animal-bite

concerns referred by Family Medicine Doctors (FAMED). Vaccination time is open from Monday to Saturday.




Charter

Legal Basis Total

Processing

Time

Total

Fees to

be Paid

1. Pre-/Post

exposure

Prophylaxis Card

2. Blotter Sheet

SLH OPD

Operational

Manual

1. Patient will proceed to the

designated area for skin

testing. SLH OPD

Operational

Manual

45 minutes

None

2. Patient will Proceed to

Nursing Assessment

5 minutes None

3. Patient will proceed to

Vaccination Area

10 minutes None

TOTAL 1 hour None








(1) NAME OF DEPARTMENT/AGENCY/LGU:SAN LAZARO HOSPITAL / ALLIED MEDICAL DIVISION /

PHARMACY DEPARTMENT



GOVERNMENT

SERVICE


Governing

Law(s)

(Number and

Short Title)36

Specific

Provision in

the Governing

Law(s) as

Basis37

Issuance/Policy

Title

Date of

Effectivity

Other

Issuances/Policies

it Effectively

Repeals/Amends

PROCESSING OF

HOSPITAL

ISSUANCE OF

DRUGS/MEDICINE

FOR ADMITTED

Republic Act

5921

PHARMACY

LAW

Section 1 ,the

supervision,

control and

regulation of

the practice of

pharmacy in

the Philippines

SLH Pharmacy

Department

Operational

Manual

2018 None

Republic Act

6675

GENERICS ACT

OF 1988

Section 2, To

promote,

encourage and

require the use

of generic

terminology in

the

importation,

manufacture,

distribution,

marketing,

advertising and

promotion,

prescription

and dispensing

None








of drugs.

Republic Act

9165

DANGEROUS

DRUGS ACT

Section 2, To

safeguard the

integrity of its

territory and

well-being of

its citizenry

particularly the

youth, from the

harmful effects

of dangerous

drugs on their

physical and

mental well-

being.








GOVERNMENT SERVICE: PROCESSING OF HOSPITAL ISSUANCE OF DRUGS/MEDICINE FOR ADMITTED

SERVICE INFORMATION Processing of Issuance of Drugs/Medicines for (Clinical Wards and Special Areas)


Requirement Legal

Basis

Client Steps/Procedures as


Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

1. RIS - form

(Requisition

Issuance Form)

with patient's

name and

hospital number

2. ARF - form

(Anti-Microbial

Restriction form)

3. Prescription

Special

prescription for

dangerous drugs

(SPFDD) for

Dangerous drugs,

prescription with

S2 license

RA 5921

Pharmacy

Law

RA 6675

Generics

Act of

1988

RA. 9165

Dangerous

Drugs Act

1. Present RIS, ARF and

SPFDD for dangerous drugs

request

SLH Pharmacy

Department

Operational

Manual

10

MINUTES

Refer to the

pricelist

below

EO 292 –

Instituting the

“Administrative

Code of 1987”

Republic Act







No. 747

entitled “An

Act to Regulate

the Fees to be

Charged

Against

Patients in

Government

Hospitals and

Charity Clinics

Classifying

Patients

According to

Their Financial

Condition”

TOTAL 46 minutes








GOVERNMENT SERVICE: PROCESSING OF HOSPITAL ISSUANCES OF DRUGS/MEDICINE FOR OUT-PATIENT

SERVICE INFORMATION Processing of Issuance of Drugs/Medicines For (Out-Patient Department)


Requirement Legal

Basis



Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

Present Original

1. Prescription

2. PEP ( Rabies

Post Exposure

Prophylaxis ) Card

3. Assessment

form

4. Senior Citizen /

PWD ID and

Medicine Booklet

5. Endorsement

letter (For

Availing of

Medical

assistance)

RA 5921

Pharmacy

Law

RA 6675

Generics

Act of

1988

RA. 9165

Dangerous

Drugs Act

1. Present Prescription, PEP

(Rabies Post Exposure

Prophylaxis) Card, Senior

Citizen / PWD ID and

Medicine Booklet.

SLH Pharmacy

Department

Operational

Manual

46

MINUTES

Refer to the

pricelist

below

2. Present the endorsement

letter, prescription and

assessment form

EO 292 –

Instituting the

“Administrative

Code of 1987”

Republic Act

No. 747

entitled “An

Act to Regulate

the Fees to be

Charged

Against

Patients in

Government

Hospitals and

Charity Clinics

Classifying

Patients

According to

Their Financial







Condition”

TOTAL 46 minutes








GOVERNMENT SERVICE: DISPENSING ARV DRUGS FOR HIV/AIDS PATIENT

SERVICE INFORMATION Processing of ARV releasing/dispensing for PLHIV clients Monday to Friday 8:00am to

4:00pm (No Noon break)


Requirement Legal

Basis



Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

1. Prescription

/Follow-up form

or Enrollment

2. Health

Regimen Booklet

RA 5921

Pharmacy

Law

RA 6675

Generics

Act of

1988

RA. 9165

Dangerous

Drugs Act

1, Instruct

patient/relatives/watchers to

present prescription, follow-

up form, ANTI RETRO VIRAL

( ARV ) booklet to pharmacist

at the satellite pharmacy

SLH Pharmacy

Department

Operational

Manual

10 minutes

Refer to the

pricelist

below

EO 292 –

Instituting the

“Administrative

Code of 1987”

Republic Act

No. 747

entitled “An

Act to Regulate

the Fees to be

Charged

Against

Patients in

Government

Hospitals and

Charity Clinics

Classifying

Patients

According to







Their Financial

Condition”

TOTAL 10 minutes



















































PHYSICAL MEDICINE REHABILITATION DEPARTMENT



GOVERNMENT

SERVICE


Governing

Law(s)

(Number and

Short Title)41

Specific

Provision in

the

Governing

Law(s) as

Basis42

Issuance/Policy

Title

Date of

Effectivity

Other

Issuances/Policies it

Effectively

Repeals/Amends

PHYSICAL

MEDICINE and

REHABILITATION

SERVICES FOR

WALK-IN

PATIENT

There is no

governing law

None SLH Physical

Medicine

Rehabilitation

Department

Operational

Manual

2018 None









GOVERNMENT SERVICE: PHYSICAL MEDICINE and REHABILITATION SERVICES FOR WALK-IN PATIENT

SERVICE INFORMATION Physical Medicine and Rehabilitation Department (PMRD) provides holistic

multidisciplinary patient-centered rehabilitation services to promote improvement in their functional

outcomes in relation to their impairment, activity limitation, and participation restriction. The consultation

hour of Physiatrist is from 9:00AM to 11:00AM / Mondays, Wednesdays, Thursdays and Fridays. Physical

Therapy and Occupational Therapy Services is open from Mondays to Fridays 7:00AM to 12:00Noon and

1:00PM to 4:00PM. Physical Medicine and Rehabilitation Department is located at the second floor of the OPD

building.




Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

Copy of Blotter

Sheet

SLH Physical

Medicine

Rehabilitation

Department

Operational

Manual

1. Bring the blotter sheet to

the PMRD SLH Physical

Medicine

Rehabilitation

Department

Operational

Manual

15 minutes None

2. After consultation, Bring

the Therapy Referral Form

to Physical Therapist or

Occupational Therapist

10 minutes None









GOVERNMENT SERVICE: PHYSICAL MEDICINE and REHABILITATION SERVICES FOR EMC OUT-PATIENT

SERVICE INFORMATION Physical Medicine and Rehabilitation Department (PMRD) provides holistic

multidisciplinary patient-centered rehabilitation services to promote improvement in their functional

outcomes in relation to their impairment, activity limitation, and participation restriction. The consultation

hour of Physiatrist is from 9:00AM to 11:00AM / Mondays, Wednesdays, Thursdays and Fridays. Physical

Therapy and Occupational Therapy Services is open from Mondays to Fridays 7:00AM to 12:00Noon and

1:00PM to 4:00PM. Physical Medicine and Rehabilitation Department is located at the second floor of the OPD

building.




Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

Inter-pavilion

referral form

Blotter Sheet

SLH Physical

Medicine

Rehabilitation

Department

Operational

Manual

1. Bring the Inter-pavilion

referral form and blotter

sheet to the PMRD

SLH Physical

Medicine

Rehabilitation

Department

Operational

Manual

15 minutes

None

2. If patient needs

therapeutic intervention,

the Physiatrist will fill-up

the Therapy Referral form

and give the order to

Physical Therapist or

Occupational Therapist

10 minutes None









(1) NAME OF DEPARTMENT/AGENCY/LGU: SAN LAZARO HOSPITAL / ALLIED MEDICAL DIVISION /

RADIOLOGY DEPARTMENT


No


GOVERNMENT

SERVICE


Governing

Law(s)

(Number and

Short Title)45

Specific

Provision in

the

Governing

Law(s) as

Basis46

Issuance/Policy

Title

Date of

Effectivity

Other


Effectively

Repeals/Amends

RADIOLOGIC

/ULTRASOUND

PROCEDURE

FOR OUT-

PATIENT

RA No. 11223

“Universal

Health Care

Act"

Section

2. Declaration

of Policy.

(a) There

shall be

total

coverage

of medical

services

according

to the

needs of

patients

Section

3. General

Administrative

Order (AO) no.

149

Basic Standards

on Radiation

Protection and

Safety

Governing the

Authorization

for the

Introduction

and Conduct

Practices

Involving X-ray

Services in the

Philippines.

May 17,

2018

None








Objectives

(b) Ensure

that all

Filipinos are

guaranteed

equitable

access to

quality and

affordable

health care

goods and

services, and

protected

against

financial risk.

.








GOVERNMENT SERVICE: RADIOLOGIC /ULTRASOUND PROCEDURE FOR OUT-PATIENT

SERVICE INFORMATION Provision of radiologic and utrasound procedure for out-patient




Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

X-ray/Ultrasound

request

SLH

Radiology

Department

Operational

Manual

1. Presents x-ray request to

the Radiology Department

CSGH

Radiology

Department

Operational

Manual

30 minutes

None

Republic Act

No. 747

entitled “An

Act to Regulate

the Fees to be

Charged

Against

Patients in

Government

Hospitals and

Charity Clinics

Classifying

Patients

According to

Their Financial

Condition”

For

Ultrasound:

Php 500.00

- Php

1200.00;

For X-Ray :

Php 200.00

- Php

600.00

TOTAL

30 minutes For

Ultrasound:

Php 500.00

- P 1200.00;

For X-Ray :

Php 200.00

- P600.00








GOVERNMENT SERVICE: CT-SCAN PROCEDURE FOR IN-PATIENT AND OUT-PATIENT

SERVICE INFORMATION Provison of ct-scan procedure for in-patient and out-patient




Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

Ct- Scan request,

any previous

laboratory and

radiologic results

SLH

Radiology

Department

Operational

Manual

1. Presents ct-scan request

to the Radiology Department

CSGH

Radiology

Department

Operational

Manual

2 hours

Pls. see

pricelist

below

Republic Act

No. 747

entitled “An

Act to Regulate

the Fees to be

Charged

Against

Patients in

Government

Hospitals and

Charity Clinics

Classifying

Patients

According to

Their Financial

Condition”

TOTAL 2 hours







PRICELIST FOR CT SCAN PROCEDURES

EXAMINATIONS

PLAIN STUDY

CONTRAST AND

SUPPLIES

TOTAL

RECOMMENDED

PRICE W/ 30%

MARK-UP

1. Head/Cranial P2,048.50 P1,855.95 P3,904.45 P5,100 w/ contrast 2,700 w/o contrast

2. PNS 2,048.50 1,855.95 3,904.45 5,100 w/ contrast 2,700 w/o contrast

3. Oropharynx 2,048.50 1,855.95 3,904.45 5,100 w/ contrast 2,700 w/o contrast

4. Nasopharynx 2,048.50 1,855.95 3,904.45 5,100 w/ contrast 2,700 w/o contrast

5. Orbital 2,048.50 1,855.95 3,904.45 5,100 w/ contrast 2,700 w/o contrast

6. Cervical/Neck 2,348.50 1,855.95 4,204.45 5,500 w/ contrast 3,100 w/o contrast

7. Chest Thoracic 2,348.50 1,855.95 4,204.45 5,500 w/ contrast 3,100 w/o contrast

8. Whole Abdomen 4,776.16 3,701.95 8,478.11 11,100 w/ contrast 6,200 w/o contrast

9. Upper Abdomen 2,348.50 1,855.95 4,204.45 5,500 w/ contrast 3,100 w/o contrast

10. Lower

Abdomen

2,348.50 1,855.95 4,204.45 5,500 w/ contrast 3,100 w/o contrast

11. Humerus 2,348.50 1,855.95 4,204.45 5,500 w/ contrast 3,100 w/o contrast

12. Forearm 2,048.50 1,855.95 3,904.45 5,100 w/ contrast 2,700 w/o contrast

13. Hand/Wrist 2,048 1,855.95 3,904.45 5,100 w/ contrast 2,700 w/o contrast

14. Leg 2,348.50 1,855.95 4,205.45 5,500 w/ contrast 3,100 w/o contrast

15. Foot/Ankle 2,048.50 1,855.95 3,904.45 5,100 w/ contrast 2,700 w/o contrast

16. Lumbar Spine 2,348.50 1,855.95 4,204.45 5,500 w/ contrast 3,100 w/o contrast









RESPIRATORY THERAPY UNIT



GOVERNMENT

SERVICE


Governing

Law(s)

(Number and

Short Title)49

Specific Provision

in the Governing

Law(s) as Basis50

Issuance/Policy

Title

Date of

Effectivity

Other


Effectively

Repeals/Amends

RESPIRATORY

THERAPY

SERVICES

Republic Act

10024

(Philippine

Respiratory

Therapy Act

of 2009)

Section 27

(a) Performs and

recommends

tentative

interpretation of

tests obtained

from physiological

specimens which

will assist in the

diagnosis and

determination of

the degree of

impairment of

relevant aspects of

cardiopulmonary

efficiency;

(c) Performs

pulmonary

function testing

maneuvers;

(d) Performs

SLH Respiratory

Therapy Unit

Operational

Manual

None








cardiopulmonary

resuscitation and

provide an

artificial airway;

(e) Administers

mechanical

ventilatory

support;

(f) Administers

pharmacologic

agents related to

respiratory care

procedures;

(g) Offers

bronchopulmonary

hygiene

procedures to

improve

pulmonary status;








GOVERNMENT SERVICE: RESPIRATORY THERAPY SERVICES

SERVICE INFORMATION Respiratory Therapy Unit provides Mechanical ventilator calibration, set up and

monitoring, Arterial blood gas extraction and providing Aerosol based medication.




Charter

Legal Basis Total

Processing

Time

Total Fees

to be Paid

Referral form

coming from the

concerned ward

with the specific

order of

procedure.

SLH

Respiratory

Therapy

Unit

Operational

Manual

1. Presents referral form to

Respiratory Therapy Unit Staff

SLH

Respiratory

Therapy

Unit

Operational

Manual

40 minutes

None

TOTAL 40 minutes





