[ DOH ADMINISTRATIVE ORDER NO. 85-A, February 22, 1990 ]
REVISED RULES AND REGULATIONS GOVERNING ACCREDITATION OF MEDICAL CLINICS AND HOSPITALS AND CONDUCT OF MEDICAL EXAMINATION FOR OVERSEAS WORKERS AND SEAFARERS
SECTION 2. Authority - These rules and regulations are issued to implement the functions of the Bureau of Licensing and Regulation under Section 13-C of Executive Order 119 and the Memorandum of Agreement between the Department of Health (DOH) and the Department of Labor and Employment (DOLE); and the DOH and the MARITIME INDUSTRY AUTHORITY ( MARINA).
SECTION 3. Purpose - The rules and regulations are promulgated in order to establish, regulate, and upgrade the standards of medical service and/or examination of overseas landbased workers and seafarers for interisland/overseas employment and to ensure that only occupationally qualified and physically and medically fit workers/seafarers participate in the overseas/ interisland employment program.
SECTION 4. Scope - These regulations shall apply to duly licensed and registered medical clinics, hospitals and laboratories desirous of participating and offering their services to private recruitment entities and manning agencies, and shipping companies in the medical examination of overseas workers and seafarers for overseas or interisland employment.
SECTION 5. Regulatory Authority - The Department of Health through the Bureau of Licensing and Regulation in the Office of Standards and Regulation shall exercise licensing, accreditation and regulatory functions under these rules and regulations.
SECTION 6. Classification of Clinics -
6.1 Regular land-based overseas workers clinic - a clinic that conducts examination on land-based workers for overseas employment. These clinics are required to post a bond of P30 ,000.00 with the Bureau of Licensing and Regulation, Department of Health.
6.2 Seafarers clinic - a clinic that conducts examination of seafarers to local and foreign employment. These clinics are required to post a bond of P30 ,000.00 with the Bureau of Licensing and Regulation, Department of Health.
6.3 Seafarers and land-based overseas workers clinic - is one that conducts examination of overseas and land-based workers. These clinics are required to post a bond of P30 ,000.00 with the Bureau of Licensing and Regulation, Department of Health.
6.4 In-house (land-based/seafarers) clinic - is a clinic that conducts examination on land-based workers or seafarers for one particular agency/company. These clinics except for those owned by the company, are required to post a bond of P30 ,000.00 with the Bureau of Licensing and Regulation, Department of Health.
SECTION 7. Accreditation Requirements (Technical Standards)
7.1 The following requirements shall be complied with by a medical clinic or hospital applying for accreditation as land-based clinic.
7.1.1. Adequate clinic facilities such as examining table, stethoscope, Mercury sphygmomanometer, clinical scale, examining light, Snellens and Jaeger Charts, otoscope, fundoscope, pair of gloves.
7.1.2 X-ray facilities duly licensed by the Bureau of Licensing and Regulation, certificate of which shall be attached to the application for accreditation.
7.1.3 In case the clinic maintains a laboratory, it should have a license to operate from the Bureau of Research and Laboratories. It shall have adequate facilities to perform the following examinations: CBC, Blood Typing, Hemoglobin determination, Pregnancy test, Filariasis, Laboratories performing HIV testing should be accredited by the BRL-DOH.
7.1.4 Physical Plant of the Clinic shall include:
a. Reception room spacious enough to accommodate at least ten (10) applicants comfortably at a time.
b. Consultation room
c. Treatment/examination room
d. Laboratory room
e. Dental room with dental unit
f. Psycho room
g. Comfort rooms separate for male and female but for those with twenty (20) applicants or less per day one (1) comfort room is sufficient.
7.1.5 Clinic staff should include the following:
1. Two (2) full time examining registered physicians, one (1) male and one (1) female with a minimum of two (2) years active practice and of good moral standing. In case the clinic has less than 40 clients per day one female physician may be sufficient.
2. One cardiologist - may be part-time (consultant)
3. One pathologist - for those with laboratories
4. Radiologist - full time or part-time (consultant)
5. Two (2) registered nurses. For in-house clinics, one nurse will do.
6. Psychologist
7. Medical Radiation Technician
8. Medical Technologist (for those with laboratories)
9. Dentist
10. Medical Aide
11. Messenger
7.2 For a clinic that will conduct examination of seafarers the following are the additional requirements: aDSIHc
7.2.1 Space and facilities for examination of visual acuity, color perception using Ishihara test, hearing and speech test.
7.2.2 EENT Consultant
7.2.3 Facilities for audiometry or contract of affiliation with a DOH-Accredited Clinic with such facilities.
SECTION 8. Guidelines on the Conduct of Medical Examination - The following guidelines shall govern the conduct of medical examinations for land-based workers and seafarers.
8.1 Who shall conduct medical Examination for land-based workers or seafarers?
Medical examination of land-based workers and seafarers both for interisland and overseas employment shall be conducted only by hospitals, medical clinics and laboratories duly accredited for the purpose. Agencies/companies shall have their recruits medically examined only by accredited hospitals or medical clinic.
Agency refers to a private recruitment entity, private employment agency or manning agency duly authorized/licensed by the Philippine Overseas Employment Administration, DOLE, to recruit and deploy workers overseas.
A shipping company refers to any Philippine Registered Shipping Company engaged in local/foreign trade.
8.2 When to conduct Medical Examination?
Medical examination of overseas workers and seafarers both for interisland and overseas employment shall be conducted only after the Agency or its principal/company has interviewed and trade tested or has decided to accept the worker/seafarer for employment. The Agency/Company Medical Examination Referral Slip issued to the worker/seafarer shall state this information.
This referral slip refers to a form duly accomplished and issued by an agency/company addressed to an accredited medical clinic or hospital to conduct medical examination on the worker named therein.
8.3. Scope of Pre-employment Medical Examination.
Unless otherwise stated in the Medical Examination Referral Slip, the pre-employment medical examination shall include the following:
8.3.1 Complete physical examination
8.3.2 Chest X-ray using plates not smaller than 11" x 14"
8.3.3 Complete blood count (CBC) including hemoglobin determination
8.3.4 Blood typing (ABO)
8.3.5 Urinalysis
8.3.6 Stool examination
8.3.7 Dental examination
8.3.8 Psychometric evaluation
8.4 For Seafarers:
8.4.1 All the above examination, plus visual acuity and with emphasis on color perception specifically for Ishihara Test.
8.4.2 Hearing and audiometry required for all officers, engine watchkeeper and radio officers;
8.4.3 Speech test for radio officers.
8.5 Test for HIV Antibodies, Hepatitis-B Antigen, or VDRL when required by country of destination.
8.6 In case the applicant is 40 years and above, the pre-employment medical examination shall include an electrocardiographic examination. For applicant below 40 years such examination shall be done when required by the employer.
8.7 Other medical tests not included in the scope of the pre-employment medical examination as defined above may be conducted on land-based workers and seafarers upon request by the Agency or its Principal/Company.
8.8 Submission of medical examination results. In order to hasten the deployment process, medical findings on land-based workers/seafarers officially referred to hospital/clinic for pre-employment medical examination shall be submitted to the referring agency/company within 48 hours after referral. In the event that medical findings indicate the need for certain minor ailments to be treated, the clinic or hospital shall advise the agency/company of the estimated period of time that said treatment shall be undertaken so that the same may be referred to the principal/company for his acquiescence.
8.9 Medical rating system. In order to standardize the medical examination of workers/seafarers the hospital or medical clinic shall use the prescribed Medical Rating Form and Medical Examination Records Form.
SECTION 9. Integrity of Medical Examination Results - The hospital or medical clinic shall guarantee the integrity of its medical examination results for a period of three months. As part of this guarantee, the clinic/hospital shall file with its clients Agency or Company and the Department of Health and affidavit of undertaking. The cost of repatriation and other expenses shall be shouldered by the clinic in the event the employer rejects the accepted applicant or terminates the employment of the workers/seafarers within a period of three (3) months from the date of examination due to medical reasons. This includes major cardiac and/or pulmonary conditions like advanced pulmonary tuberculosis, pulmonary tumor, bronchiectasis, cardiomegaly, congestive heart failure and such other illness the progress or state of which could have been detected during the pre-employment medical examination under Section 8.
SECTION 10. Whenever the result of medical examination is contested by an applicant, recruitment agencies, companies or other interested parties, the Bureau of Licensing and Regulation (BLR) may be assisted by experts in medical specialties or psychologists as needed to review the results. Recommendations will be referred to the Bureau of Licensing and Regulation, Department of Health.
SECTION 11. Standard Medical Examination Fees - In order to standardize and upgrade the quality of pre-employment medical examination of overseas workers and seafarers, accredited hospitals and medical clinics shall follow strictly the schedule of fees which shall be prescribed by the Bureau of Licensing and Regulation in charging the workers/seafarers or agency/company.
SECTION 12. Responsibilities of Medical Clinics or Hospitals - In addition to complying with all the above requirements, it shall be the responsibility of an accredited medical clinic and hospital to:
12.1 Ensure compliance by its staff with the Code of Ethics of their respective professions in the Philippines.
12.2 Submit to the Bureau of Licensing and Regulation, Department of Health a monthly report of the workers/seafarers it has medically examined per agency/company.
12.3 Continually upgrade its facilities and the competencies of its medical staff.
12.4 Ensure that medical examination of workers/seafarers are done only at its premises and are conducted by its practitioners-staff duly identified in the application for accreditation.
12.5 Make sure that workers/seafarers are not subjected to unnecessary and prolonged medication for nonexistent ailments or sickness.
SECTION 13. Basic Accreditation Requirements - Any licensed hospitals registered medical clinics desirous of getting accredited to service overseas workers/seafarers including seafarers on domestic trade shall submit the following requirements:
13.1 Letter of application on the prescribed form of the Bureau of Licensing and Regulation.
13.2 Bureau of Domestic Trade Registration for single proprietorship or Securities and Exchange Commission Registration for partnership or corporation.
13.3 License to operate and maintain a laboratory from the Bureau of Research and Laboratories for clinics that have their own laboratories. In case the clinic has no laboratory of its own a copy of affiliation agreement with and a copy of license to operate from the Bureau of Research and Laboratories of the laboratory to which the clinic is affiliated shall be submitted.
13.4 License to operate from the Bureau of Licensing and Regulation for hospitals, or Mayor s permit to operate a clinic.
13.5 Certificate of accreditation from the Bureau of Research and Laboratories for HIV testing laboratories.
13.6 License to operate an X-ray facility from the Bureau of Licensing and Regulation.
13.7 Professional Tax Receipts (PTR) of practitioner staff of the clinic or hospital who will involved in the examination of workers/seafarers for overseas employment.
13.8 NBI clearances of officers/practitioners staff identified above.
13.9 Valid Professional Regulation Commission (PRC) Identification Card of the medical staff and paramedical staff.
13.10 Location map or sketch of the location of the clinic should be attached to the application.
13.11 For regular land-based or seafarers clinic, a cash bond of Thirty thousand pesos (P30 ,000.00) shall be deposited with the Department of Health and the xerox copy of the official receipt shall be submitted together with the application.
SECTION 14. Application for Accreditation - Application for accreditation shall be filed with the Bureau of Licensing and Regulation in the form prescribed by the Bureau.
14.1 Each application shall be signed under oath or affirmation by the applicant or the person duly authorized to act for and on his behalf.
14.2 Any material false statement in this application or failure to comply with the requirements may serve as basis for refusal to issue a certification of accreditation.
14.3 Application fee of One thousand pesos (P1 ,000.00) shall accompany the application together with the supporting papers enumerated in Section 13.
14.4 Any accredited clinic or hospital which desires to perform medical examination on seafarers for inter-island and overseas employment may apply for accreditation in the appropriate category.
SECTION 15. Accreditation Fee -
15.1 A non-refundable fee of One thousand pesos (P1 ,000.00) shall be paid upon approval of the application for accreditation. A clinic shall pay an accreditation fee of P1 ,000.00 regardless of category.
15.2 All fees shall be payable to the Bureau of Licensing and Regulation to be paid to the Cashier of the Department of Health.
15.3 A penalty of Five hundred pesos (P500.00) for late renewal shall be charged in addition to the renewal fee of hospital/clinic if the application is filed during the next three (3) months after anniversary date.
15.4 The certificate of accreditation shall be considered lapsed if not renewed within three months after expiration. Subsequently any application shall be subject to an application fee.
SECTION 16. Separate Accreditation - Separate accreditation shall be required for clinics/hospitals or branches thereof, maintained in separate premises even though they are operated under the same management.
SECTION 17. Inspection - Accredited hospitals and clinics shall be inspected regularly and records shall be made available to determine compliance with the rules and regulations.
17.1 Each accredited hospital or clinic shall give the Director, Bureau of Licensing and Regulation (BLR) or his authorized representative(s) at any reasonable time the opportunity to inspect the hospital or clinic.
17.2 Each accredited hospital or clinic shall make available to the Director, Bureau of Licensing and Regulation or his duly authorized representative(s) records kept by them for inspection pursuant to these regulations.
17.3 The Director of the Bureau of Bureau of Licensing and Regulation or his representatives may be assisted by duly designated experts from professional associations in such inspection.
17.4 Director of Regional Health Offices, Provincial, City and Municipal Health Officers are hereby empowered to report the existence of medical clinics examining overseas workers or seafarers without proper accreditation and any violation of these rules of the Bureau of Licensing and Regulation.
SECTION 18. Issuance of Certificate of Accreditation
18.1 After the clinic is found to have met all the requirements including payment of the accreditation fees, the application shall be approved by the Undersecretary of Health for Standards and Regulation upon recommendation by the Director, Bureau of Licensing and Regulation, and a certificate of accreditation shall be issued.
18.2 A provisional accreditation shall be granted to hospitals or clinics for a duration of one (1) to three (3) months in the meantime that all necessary requirements and standards governing their operation are not fully complied with.
18.3 Upon written appeal duly verified by the applicant or accredited hospital/clinic, the Undersecretary of Health for Standards and Regulation or his duly authorized representative shall conduct an inquiry to determine the justifiability of the recommendation of the Director, Bureau of Licensing and Regulation in denying issuance of certificate of accreditation enclosing therewith a certified copy of the recommendation sought to be reviewed.
SECTION 19. Terms and Conditions of the Accreditation Certificate -
19.1 The certificate of accreditation and any right granted under the accreditation shall not be assigned or transferred.
19.2 Accreditation shall be automatically terminated upon change of ownership or change in location, therefore in either case a reaccreditation has to be applied for and approved by the Undersecretary of Health for Standards and Regulation upon recommendation by the Director, BLR.
19.3 Change of ownership or location shall be reported in writing to, and acknowledged by the Bureau of Licensing and Regulation fifteen days from the effectivity of such change.
SECTION 20. Exhibition of Certificate - The certificate of accreditation of the clinic/hospital must be posted in a conspicuous place readily seen by the public. A copy of the Rules and Regulations shall be readily available for guidance of all the staff and personnel of the hospital or clinic. The certificate of accreditation shall expire one year after issuance.
SECTION 21. Renewal -
21.1 Application for renewal of certificate of accreditation shall be filed within sixty (60) days prior to the date of expiration. A penalty shall be paid if the renewal is filed after the anniversary date in accordance with Section 15.
21.2 The Bureau of Licensing and Regulation shall process application for renewal immediately upon receipt thereof subject to ocular inspection by the inspection team. The accredited clinic/hospital shall continue operation during the final action of its application unless otherwise advised or ordered by the Director of the Bureau of Licensing and Regulation.
21.3 An accreditation that has not been renewed for a period of three (3) months after expiration shall be considered lapsed and the registration of the clinic shall be cancelled. Applicants for reaccreditation shall be required before such hospital/clinic can be allowed to operate for purpose of overseas employment. No authentication shall be done on documents submitted by these clinics or hospitals until they are accredited.
SECTION 22. Publication of List of Accredited Hospitals/Clinics -
22.1 A list of accredited clinics/hospitals shall be published periodically and shall be made available to any person, agency or company for legitimate purpose.
SECTION 23. Modification and Revocation of Accreditation - The terms and conditions of each Certificate of Accreditation shall be subject to amendments to these regulations as the Secretary of Health may deem necessary. Except in cases of willful or repeated violations hereof, or where public health interest or safety requires otherwise, no accreditation shall be modified, suspended or revoked unless prior notice has been made and the corresponding investigation has been conducted.
SECTION 24. Authentication of Medical and Aids Clearance Certificates -
24.1 Medical and AIDS Clearance certificates issued by duly accredited medical clinics or hospitals only shall be authenticated by the Department of Health.
24.2 An authentication fee of Ten pesos (P10.00) shall be charged per medical certificate.
24.3 Authentication shall be done by the Bureau of Licensing and Regulation, Accreditation and Authentication Section.
SECTION 25. Violation and Penalties -
25.1 Violation of the rules and regulations governing accreditation of medical clinics and hospitals and the conduct of medical examination for overseas workers and seafarers and/or commission of the following acts by persons operating the hospital or clinic or persons under their authority shall be penalyzeable.
25.1.1 Clinics/hospitals issuing medical and/or laboratory examination reports without actually performing them.
First Offense - one month suspension of accreditation.
Second Offense - three months suspension of accreditation.
Third Offense - revocation of accreditation.
25.1.2 In-house clinics performing examination on applicants or agencies or companies other than the one specified in their application for accreditation.
First Offense - 6 months suspension of accreditation.
Second Offense - revocation of accreditation.
25.1.3 Clinics performing laboratory examination in its own unlicensed laboratory instead of collecting specimens from applicants and sending them to the laboratories to which they are affiliated.
First Offense - one month suspension of accreditation.
Second Offense - three months suspension of accreditation.
Third Offense - revocation of accreditation.
25.1.4 Change of ownership or location of the clinic/hospital without notifying the Bureau of Licensing and Regulation.
- Denial of accreditation
25.1.5 Operating unauthorized branches for examination of overseas workers/seafarers
- Suspension/revocation of accreditation
25.1.6 Allowing other medical clinics to use their official forms of medical examination.
First Offense - three months suspension of accreditation.
25.1.7 Refusal to allow inspection of the clinic/hospital by persons authorized by the Director, BLR during working hours.
First Offense - Reprimand
Second Offense - three months suspension
Third Offense - six months suspension
Fourth Offense - revocation of accreditation.
25.1.8 Failure to correct deficiencies within a reasonable time after due notice from the Bureau of Licensing and Regulation.
First Notice - Reprimand
Second Notice - three months suspension of accreditation
Third Notice - non-renewal or revocation of accreditation.
25.1.9 Clinics found guilty of misinterpretation of pre-employment medical/laboratory examination done on applicant/overseas workers/seafarers, causing non-deployment or repatriation.
First Offense - three months suspension of accreditation.
Second Offense - six (6) months suspension of accreditation.
Third Offense - revocation of accreditation.
Suspension shall be for a minimum of one month and in no case shall exceed 6 months.
In repatration cases, garnishment of the cash bond shall be done in addition to the administrative sanctions.
SECTION 26. Investigation of Charges or Complaints - Upon receipt of duly sworn complaints or charges against an accredited clinic or hospital by any person, interested party or corporation, the Undersecretary of Health for Standards and Regulation or the Director of the Bureau of Licensing and Regulation, through their duly authorized representative shall investigate complaints or charges to verify whether the clinic or hospital is guilty of the charges.
If upon investigation, a clinic or hospital is found violating the provisions of these rules and regulation, or have committed any of the acts enumerated in the preceding section the Undersecretary of Health for Standards and Regulation shall impose the corresponding sanctions enumerated therein without prejudice to referring the case to judicial authorities for criminal action.
SECTION 27. Effectivity - These rules and regulations shall take effect fifteen (15) days after its publication in the official gazette or in a newspaper of general circulation and shall supercede all issuances inconsistent thereof including the Joint DOH-DOLE Rules and Regulations for the Accreditation of Medical Clinics and the Conduct of Medical Examination for Overseas Employment.
Adopted: 22 Feb. 1990
(SGD.) ALFREDO R.A. BENGZON, M.D.
Secretary