On July 12,2016, the Department  of Health (DOH) through the Health Facilities and  Services  Regulatory   Bureau  (formerly  Bureau  of  Health  Facilities  and Services) published Administrative Order (A.O.) No. 2016-0029 titled œRules and Regulations Governing the Licensure of Ambulances and Ambulance Service Providers  dated June 29, 2016.

The aforementioned  A.O. was drafted in line with Section VI. A. 4. of A.O. No. 2010- 0003 titled œNational Policy on Ambulance Use and Services  which stated that  the  œBureau  of  Health  Facilities  and  Services  shall  establish  licensing standards for ambulance services and ensures their implementation through regulation. The license of hospital-based  ambulance service shall be part of the hospital license. All other ambulance  services shall require a separate  license  The  policy  was  envisioned  to remedy  the  issue  on  the  misuse  of ambulance vehicles and the mislabeling of other vehicles as ambulances in the country. Moreover,   it  seeks   to  establish   that   ambulances   operate   with   competent personnel  and  appropriate  equipment  in  order  to  respond  to  medical emergencies, provide quality care and ensure patient safety.

However,  in consideration  of the  plight  of stakeholders  who  could  not  readily comply with the standards and requirements prescribed in the policy, the DOH decided to issue out Department Circular (DC) No. 2016-0357 titled Extension of Moratorium Period for Compliance for All Ambulance and Ambulance Service Providers. The DC. provided a moratorium for all ambulance service providers to comply until December 31, 2017 while the AD. underwent policy review.

After  the  conduct   of  several   consultative   meetings   with  stakeholders   and considering the context in which ambulance service providers currently operate, this Order hereby provides the revised mandatory minimum standards and requirements   for  the  licensure  of  land  ambulances   and  ambulance  service providers.


These rules and regulations  are promulgated  to protect the public and ensure the safety of patients and personnel by setting the minimum standards and requirements for land ambulances and ambulance service providers.


These rules and regulations shall apply to all government and private land ambulances and ambulance service providers.


For  purposes  of this  Order,  the  following  terms,  abbreviations  and  definitions apply:

1. Ambulance - a vehicle designed and equipped for transporting sick or injured patients to, from, and between places of treatment by land, water or air, affording safety and comfort to the patients and avoiding aggravation of illness or injury.

2.  Ambulance  Service  Provider  (ASP)  -  a  health  facility,  institution  or  entity whether government or privately owned providing ambulance services.

3. Advanced  Cardiac  Life Support  (ACLS)  - a group of interventions  used to treat and stabilize adult victims of life-threatening  cardiorespiratory  emergencies and to resuscitate victims of cardiac arrest. These interventions include CardioPulmonary   Resuscitation,   basic   and   advanced   airway   management, tracheal intubation, medications, electrical therapy and intravenous (IV) access.

4. Advance  Life  Support  (ALS)  - a set  of life  saving  protocols  and  skills  that extend BLS to further support the circulation and provide an open airway and adequate ventilation.

5. Basic Life Support (BLS) - a group of actions and interventions used to resuscitate  and  stabilize  victims  of  cardiac  or  respiratory  arrest.  These  BLS actions  and  interventions   include  recognition   of  a  cardiac  or  a  respiratory emergency  or stroke,  activation  of the emergency  response  system,  CPR and relief of foreign body airway obstruction.

6. Department of Health - License to Operate (DOH-LTO) - a formal authority issued by DOH to an individual, agency, partnership or corporation to operate an ambulance.

7. Emergency Medical Technician (EMT) - trained professional  who provide out of hospital emergency medical care and transportation for critical and emergent patients  who  access  the  emergency  medical  services  (EMS)  system.  (Ohio National Registry ofMedical Technicians, 201 7)

8. First Aid -is the immediate  assistance  provided  to a sick or injured person until professional  help arrives.  Referred  to as Standard  First Aid (SFA)  in this Order. (International Federation of Red Cross and Red Crescent Societies, 2016)

9. HFSRB-Health Facilities and Services Regulatory Bureau

10. Land Ambulance- a vehicle designed and equipped with basic or advance life support transporting patients to, from, and between places of treatment by land

11. Medical Direction- allows a paramedic or EMT to contact a physician from the field via radio or other means to obtain instruction on further care of a patient

12. Medical emergencies - any acute or life-threatening condition that requires immediate intervention by a competent personnel

13.  Patient  Transport  Vehicle  (PTV)  -  any  form  of  land  vehicle  designed  to transport patients whose condition is of a non-life threatening nature.

14.   RO-RLED-   Regional   Office-   Regulation   Licensing   and   Enforcement
Division.


1. All vehicles shall be duly registered with the Land Transportation Office under the name of the ambulance service provider prior to application for DOH-License to Operate.

2. Licensed land ambulance vehicles shall only be used for the purpose by which it was granted a license to operate.

3. No land vehicle of any kind shall bear on its body the label or marking of the word œAMBULANCE  unless it has been duly licensed and categorized as a land ambulance by the Department of Health.

4. Every ambulance service provider shall be organized to provide safe, quality, effective  and  efficient  ambulance  services  for  patients  which  shall  be  made available at all times.

5.  Ambulance   service   providers   of  privately   owned   ambulances   shall   be registered with the Department of Trade and Industry (DTI) or with the Securities and Exchange Commission (SEC), whichever is applicable.

6. For ambulance service providers of government owned ambulances, a local government ordinance/board  resolution or its equivalent as proof of ownership of ambulance vehicles shall be required.

7.  All  ambulance   service  providers   shall  have  an  Operations   Control  and Dispatch  Center of their ambulance/s  whether  it be a business  office or space and shall ensure adequate parking spaces for their ambulance/s.

8. Ambulance  service  providers  shall ensure  that they are part of a functional referral network within the area/vicinity where they shall operate.

9. The DOH-LTO  of ambulance  service  providers  of institution-based ambulances  applying  for a DOH-LTO  shall be included  in the One-Stop  Shop (OSS) system for hospitals  and other health facilities, and shall be reflected  in the  health  facility  DOH-LTO.  There  shall  only  be  one  (1)  DOH-LTO  for  the health facility indicating the number of licensed ambulances.

10. Ambulance  service  providers  of  non-institution-based   ambulances  shall secure a separate DOH-LTO.

11. Ambulance service providers shall strictly comply with the standards, criteria and requirements prescribed in the Assessment Tool for Licensing a Land Ambulance and Ambulance Service Provider (Annex C).

12.  Ambulance  service  providers  (ASP)  shall  subject  each  of  its  ambulance vehicles  for  inspection.  Any  additional  vehicle  shall  be  applied  for  inspection. Only when found compliant shall the additional vehicle be included in the existing list of approved ambulances of the ASP. Moreover, in cases when a vehicle will no longer be used as an ambulance, the ASP shall inform HFSRB/RO-RLED through  a letter  indicating  the  plate  or  conduction  sticker  number  of the  said vehicle for delisting. The delisted vehicle shall then no longer bear the marking œAMBULANCE  and the DOH Ambulance logo should be removed.

13.  Vehicles  used  to  transport  patients  but  are  not  equipped  with  Basic  Life Support (BLS) or Advance Life Support (ALS) shall be categorized as Patient Transport Vehicles.

14.  Patient  Transport   Vehicles   shall  be  used  to  transport   patients   whose condition is of a non-life threatening nature such as but not limited to scheduled visits to a physician ™s  office for treatment, routine physical examinations,  x-rays or laboratory tests, or upon discharge from a hospital.

15. Patient Transport Vehicles should not bear the marking of the word œAMBULANCE    but   shall   instead   be   labeled   as   œPATIENT   TRANSPORT VEHICLE. 

16. Patient Transport Vehicles shall not be licensed by the HFSRB but shall be registered with the Bureau using a prescribed form.


A. CLASSIFICATION OF LAND AMBULANCES

1. ACCORDING TO OWNERSHIP

a.   Government - owned, managed and operated wholly by government agencies/institutions  such  as,  but  not  limited  to, DOH  hospitals,  Local Government  Units (LGU) and LGU-run hospitals,  the Bureau of Fire Protection (BFP) and the Philippine National Police (PNP) of the Department of the Interior and Local Government (DILG), the Philippine Coastguard of the Department of Transportation   (DOTr),  the  Armed  Forces  of  the  Philippines   (AFP)  of  the Department   of  National   Defense   (DND),   Metropolitan   Manila   Development Authority (MMDA) and others.

b.  Private  -  owned,  managed  and  operated  with  funds  through  donation, principal, investment  or other means by any individual,  corporation,  association or organization.  Private ownership  may be through single proprietorship, partnership, corporation, cooperative, foundation, religious, non-government organization and others.

2. ACCORDING TO INSTITUTIONAL CHARACTER

a. Institution-based  - ambulance that is owned, operated, maintained and used by a health facility (i.e. hospital, infirmary, etc.) regulated by the Department of Health.

b.  Non-institution-based/  Free-Standing  -  ambulance  that  is  operated independently from a health facility but may be used to service a health facility through a notarized Memorandum of Agreement (MOA) /service contract or its equivalent.

B. CATEGORIZATION  OF LAND AMBULANCES

1. Type I- ambulance capable of providing Basic Life Support (BLS)

2. Type II- ambulance capable ofproviding Advance Life Support (ALS) C. CATEGORY OF AMBULANCES REQUIRED AMONG HEALTH FACILITIES

l. Ambulances are part of the licensing requirements of several types of health facilities. The category of ambulance required from a health facility shall be commensurate  to the services  provided  by the health  facility  as shown  in the table below:

Typ e of Fac ilit y	Ca t ego r y o f   A m bu l ance Requ ir ed	I f Ou t sou r ced w ith a DO H L i censed A m bu l ance Se r v i c e P r ov i der ( ASP)
Specialty and Level 3 Hospitals	Typ e II ( ALS ) Ambulance	- The A m bu l ance se r v i c i ng t he Hosp it a l s shou ld be Type I I - The re shou ld be a M O A be t ween t he hosp it al and t he ASP ( whe t her gove r n m ent o r p ri va t e ly owned) - The a mbulance vehicle should be stationed at the hospital at all times
Leve l 2 Hosp it a l s
Level 1 Hospitals	Typ e I ( BLS ) Ambulance + MOA with a hospital of higher level . May opt to have a Type II Ambulance	- The a m bu l ance se r v i c i ng t h e Hosp it a ls m ay e it her be Type I or Type I I - The re shou ld be a M O A be t ween t he hosp it al and t he ASP ( whe t her gove r n m ent o r p ri va t e ly owned)
Infirmaries

2. Hospitals and infirmaries may opt to have their own patient Transport Vehicles (PTV)1n addition to their ambulances.

3. Birthing facilities at a minimum are required to enter a MOA with ambulance service providers (whether government  or privately owned) but may also opt to own an ambulance. This shall be complemented with a MOA with a health facility of higher level. In cases wherein the birthing home ™s referral facility is also the ambulance  service  provider,  one  MOA  will  suffice  as  long  as  the  terms  for ambulance services are clearly stipulated in the said MOA.

4. All facilities opting to enter a MOA with any DOH licensed ambulance service provider shall take into consideration that the ASP servicing the facility should be able  to  respond  and  provide  ambulance  services  within  a  reasonable  time. Moreover, DOH licensed ASPs entering into MOA/s with health facilities should do so in accordance with their service capacity and capability.

D. STANDARDS

1. AMBULANCE BODY

a.  An  ambulance  vehicle  shall  be  able  to  accommodate  the  patient,  and  the required number of personnel and equipment.

b. The ambulance shall have a non-porous partition between the driver and the body of the ambulance.

c. DOH Licensed Ambulances shall bear the following markings:

i. Front: The reflectorized  and capitalized word œAMBULANCE   which is spelled out in reverse (mirror image). The height of each letter shall be no less than 10 centimeters and the word shall be seen at least six (6) meters away.

ii. Side: Each side of the ambulance body shall have the capitalized word œAMBULANCE  not less than 15 cm in height.

The name and logo of the licensee, the administrative division (Region, Province, City, Municipality and Barangay) to which the ambulance is affiliated with may be indicated on the sides of the ambulance provided that the logo/font  size used should not be more than the height of the word  œAMBULANCE.   This  shall  be  placed  below  the  word œAMBULANCE. 

iii. Rear: The reflectorized and capitalized word œAMBULANCE   not less than  15 cm  in height  and  the  prescribed  DOH  ambulance  logo  to be issued by the DOH once the application for a license is approve (Refer to Annex B: Official DOH Ambulance Logo)

iv. The licensee may also opt to mount the blue œStar of Life  emblem on any part of the ambulance vehicle.

There shall be no restrictions on the color of the ambulance vehicle or on the color of the letterings.

Any other signage  or pictures  outside  of what is prescribed  herein are not allowed.

d.   Each ambulance shall   have   adequate   and   stable   cabinet/s   that   can appropriately   store the required equipment,  medicines  and  supplies. These storages shall be easily accessible but properly secured at all times.

e. Ambulance vehicles shall have Emergency Warning Light System and Siren- Public Address System.

2. PERSONNEL

Each ambulance  shall be manned by an adequate  number of qualified, trained and   competent   staff   to   ensure   efficient   and   effective   delivery   of   quality ambulance services.

a. A minimum of at least two (2) ambulance personnel, excluding the driver, is required for every ambulance dispatched. Additional staff depends on the nature of the emergency as determined by the management of the service provider.

b. The minimum qualifications  and trainings required from ambulance personnel shall be in accordance to the type of ambulance they operate as follows:

Category of Ambulance	Minimum Qualification	Training Requirements
Type I	Graduate of any health related   4 year course	C Y 2018 - 2019: - S t anda rd F ir st A id ( SFA ) - Bas ic L ife Suppo rt ( BLS ) S t a rti n g CY 2020 onwa r ds : - SFA + BLS + E m e r genc y M ed i cal Techn i c i an ( E M T ) T r a i n i ng - Bas ic
Type II	Licensed or Registered Nu rse ( RN)	C Y 2018 : - Standard First Aid ( SFA ) - Bas ic L ife Suppo rt ( BLS ) - Advance Ca r d i ac L ife Suppo r t ( ACLS ) S t a rti n g CY 2020 onwa r ds : - SFA + BLS + ACLS + E M T T r a i n i ng- Advance / Par amedic Training

C. There shall be staff development  and continuing  education  program  to upgrade the knowledge, attitude and skills of staff.

3. EQUIPMENT, MEDICINES AND SUPPLIES

Every ambulance shall have available and operational prescribed equipment, medicines and supplies.

a. Each ambulance shall be adequately equipped with appropriate equipment, medicines  and supplies.  (Refer  to Annex  C: Assessment  Tool for Licensing  a Land Ambulance and Ambulance Service Provider)

There shall be a program for calibration, preventive maintenance and repair of equipment, including decontamination and disinfection.

There  shall  be  a  contingency   plan  in  case  of  equipment   breakdown   and malfunction, especially during patient transport.

There   shall   be  a  program   for  the  management   of  temperature   sensitive medication.

4. SERVICE DELIVERY

Every  ambulance  service  provider  shall  ensure  that  the  services  delivered  to patients comply with the standard quality embodied in the assessment tool for licensing   a  land  ambulance   and  ambulance   service   provider,   other  policy guidelines and/or related issuances.

a. Ambulance  service provider shall have documented  policies and procedures on its administrative and technical Standard Operating Procedures (SOP) for the provision of its ambulance services.

b. Ambulance  service provider shall have documented  policies and procedures on the establishment of its referral system.

Non-institution-based/Free-Standing ambulance service providers servicing the public independently  shall have a MOA with a hospital for which they can bring their  clients  for  the  needed  health  services.  [This  clause  is  not  applicable  in cases of extreme medical emergencies or in cases when patients prefer another ambulance service provider.]

c. Ambulances shall have devices to communicate to the operation center of the ambulance  service provider and the referral hospital/health  facility for recording and effective management of cases.

d. There  shall  be  guidelines  in  the  implementation  of medical  direction  when needed.

5. INFORMATION MANAGEMENT

Every ambulance service provider shall maintain a system of communication, recording and reporting of the patient ™s condition as well as the results of examinations which may include electronic communications or otherwise allowed under Republic Act (R.A.) 8792, otherwise known as the œElectronic Commerce Act  of  2000.   Moreover,  management   of  data  or  information   should  be  in adherence to RA. 10173 also known as the œData Privacy Act of 2012. 

a. Hospital/Facility Referral Form

Each form shall be kept confidential  and shall contain  sufficient  information  to identify the patient and to justify the treatment provided, which includes the information of transfer/referral of patient to another physician or health facility.

b.  Logbook

Ambulance service providers shall maintain a logbook which shall be signed by the head of the DOH licensing  team during inspection  and/or monitoring  visits. The logbook shall contain, but not be limited to, the following information:

i. Name, sex and age of patient;
ii. Name of attending physician, when applicable;
iii.  Origin  and  destination;   Date  and  time  of  dispatch  and  return  of ambulance;
iv. Reason for transfer/transport;
v. Disposition of patient. c. Submission of Reports

All  ambulance  service  providers  shall  submit  an  annual  report  utilizing  the template provided by DOH (Refer to Annex D: DOH Annual Statistical Report for Ambulance  Service Providers).  The deadline for the yearly submission  is every 31st of March of the following year (ex. CY 2018 report will be due on March 31, 2019).

6. ENVIRONMENTAL  MANAGEMENT

Every ambulance  service provider shall ensure that the environment  is safe for its patients and staff including members of the public as necessary and that the following measures and/or safeguards shall be observed:

a. The ambulance shall be properly ventilated, lighted, clean and safe.

b.  There  shall  be  a  written  plan  and  program   of  proper  disinfection   and preventive maintenance of the ambulance vehicles.

c. The use of Personal Protective Equipment (PPEs) and adherence to infection control policies shall be strictly observed.

d. There  shall be procedures  for the proper  disposal  of infectious  wastes  and toxic and hazardous substances  in accordance  with RA. 6969 known as œToxic and Hazardous Substances and Nuclear Wastes Act  and other related policy guidelines and/or issuances.

A. The processing of application for DOH-LTO shall be as follows:

Type of Application

HFSRB

RO - RLE D

 

 

Initial/Renewal

Institution-based: Ambulances of Levels 2 and 3 Hospitals. Ambulatory Surgical Clinics, Dialysis Clinics, Medical Facilities for Overseas Workers and Seafarers, etc.

  Non-Institution-based: Government owned: Ambulances of Barangay Health Stations, Rural Health Units, Health Centers, City Health Offices, Municipal Health Offices, Provincial Health Offices, LGUs, BFP, PNP, Coastguard, AFP, MMDA, etc.
Privately owned

Institution-based: Level 1 Hospitals, Birthing Homes and Infirmaries

B. The processing of applications shall be within thirty (30) days starting from the time of receipt of the complete application documents to the issuance or non- issuance of the DOH-LTO.

C. APPLICATION FOR INITIAL DOH-LTO

l. Ambulance  service providers  of institution-based  ambulances  shall follow the One-Stop Shop (OSS) system for hospitals and other health facilities.

2.  Ambulance   service  providers  of  non-institution-based   ambulances   shall follow  the  consecutive  steps:  (Refer  to  Annex  A  for  the  Process  Flow  in  the Licensure of Land Ambulances and Ambulance Service Providers- Initial)

a.  Ambulance  service  providers  shall  submit  the  following  relevant documents to HFSRB/ RO-RLED:

i.  Duly  accomplished  application  form  can  be  downloaded  from hfsrb.doh.gov.ph
ii. Proof of ownership:

For   Ambulance    Service   Providers   of   Government    owned ambulances:

a)    Enabling Act or Board Resolution or its equivalent
b)    Cooperative   Development   Authority  Registration   with Articles of Cooperation and By-laws, whenever applicable

For Ambulance Service Providers of Privately owned ambulances:

a)    Department  of Trade  and  Industry  (DTI)  or Securities and Exchange Commission  (SEC) Registration  with Articles of Incorporation and By-laws;
b)    Cooperative   Development   Authority  Registration   with Articles of Cooperation and By-laws, Whenever applicable

iii.     Registration  of  the  vehicle(s)  from  the  Land  Transportation
Office

iv. License of the ambulance driver/s as Professional  Driver, from the Land Transportation Office

b. Pay the corresponding  fee, and submit a copy of the official receipt to HF SRB/ RO-RLED.

c. The HFSRB/ RO-RLED shall receive and evaluate the completeness of documentary  requirements  submitted  including  proofs  of payment.  A complete application means that the required documents, as specified in the application  checklist  of HFSRB/RO-  RLED,  have been submitted.  If incomplete, the client shall be given thirty (30) days to submit the complete documentary requirements. The application payment will be forfeited if the complete  documentary  requirements  are  not  submitted  within  thirty  (30) days.

d.  For complete applications, the inspection team of HFSRB/RO- RLED shall inspect the ambulance vehicle/s. The applicant shall ensure that all key staff, pertinent  records,  and  ambulance  vehicles  are  made  available  to HFSRB/RO-RLED during inspection visits.

If during inspection, the ambulance vehicle/s is/are found non-compliant to the standards and requirements for the licensing of ambulances, the inspection team from the concerned offices shall notify the applicant of their deficiencies and the ASP shall be given time to comply within the prescribed timeline  (maximum   of  30  days).  The  counting  of  days  to  process  the application shall be stopped ( œstop-clock ) until all deficiencies have been complied with. Failure to complete the compliance  within the timeline given

shall mean disapproval of the application and forfeiture of payment. The HFSRB/RO-RLED shall then send the Letter of Denial with the noted deficiencies to the applicant.

If   found   compliant   during   inspection,    the   inspection   team   shall recommend the issuance     of the DOH-LTO.

e.   The  Director   IV  of  HFSRB/RO   Director,   or  in  his/her   absence   or unavailability   or  when  delegated,  the  Director  111  of  HFSRB/RO,  shall approve the issuance of the DOH-LTO.

f.    Once the DOH-LTO has been issued to the ambulance service provider, each compliant  ambulance  vehicle  of the licensed  ASP shall be given the Official  DOH  Ambulance  Logo  with  its  corresponding  plate  or  conduction sticker number, ambulance  category and the year until when the DOH-LTO of the ASP will be valid. The logo shall then be mounted at the rear of the vehicle. Moreover, all ambulance  vehicles should have a copy of the DOH- LTO of the ASP.

D. APPLICATION FOR RENEWAL OF DOH-LTO

1.  Ambulance service providers of institution-based  ambulances shall follow the One-Stop Shop (OSS) system for the renewal of their DOH-LTO.

2. Ambulance service providers of non-institution-based ambulances shall follow the consecutive steps:

a. Submit the following documents:

i.   Duly   accomplished   application   form.   This   form   can   be downloaded from hfsrb.doh.gov.ph.
ii. DOH annual ambulance statistical report
ii. other relevant records as may be required by DOH

b. The same steps and timelines outlined in Section VII. C.2. b.-f. of this Order shall apply.

3. The DOH-LTO of an ambulance service provider shall be cancelled automatically without notice upon failure to submit a duly accomplished application form and to pay the proper fee beyond thirty (30) days from the date of expiration stated in its license. Thereafter, the service provider shall apply for an initial DOH-LTO.

E. MONITORING

1.   Licensed  ambulance  service  providers  and  its  ambulances  shall  be monitored regularly.

2. The HFSRB or RO-RLED shall conduct periodic monitoring visits utilizing the assessment tool for licensing a land ambulance and ambulance service provider.

3.  The  applicant  shall  ensure  that  all  key  staff,  records,  premises  and facilities  are  made  available  to  HFSRB  or  RO-RLED  during  monitoring activities.

4.  A Notice of Violation shall be issued immediately for non-compliance with these rules and regulations.

VIII. VALIDITY OF LICENSE TO OPERATE

The DOH-LTO of ambulance service providers of institution-based ambulances shall be valid for one (1) year only following the OSS system for hospitals and other health facilities, while for ASP of non-institution-based ambulances, the DOH-LTO shall be valid for three (3) years from January of the first year to December of the third year.

IX.  SCHEDULE OF FEES

A. A non-refundable fee shall be charged for the application of DOH-LTO of an ambulance   service   provider   and  its  land  ambulances   (Refer  to  Annex  E: Schedule of Fees in the Licensure of Land Ambulances and Ambulance Service Providers):

B. All fees/checks shall be paid to the order of DOH in person or through postal money order [or through bank to bank payments as soon as the system becomes functional].

C. All fees, surcharges and discounts shall follow the current DOH prescribed schedule of fees in AO. No. 2007 - 0001 œRevised Schedule of Fees for Certain Services Rendered by the Bureau of Health Facilities and Services and Centers for Health Development... ,  A.O. No. 2007 - 0023 regarding œSchedule of Fees for the One-Stop  Shop Licensure  System  for Hospitals ,  and AD. No. 2008 -0028  œSchedule  of Fees  for the One-Stop  Shop  System  for the Regulation  of Medical Facilities for Overseas Workers and Seafarers and Non-Hospital Based. . . , other policy guidelines and/or relevant issuances.

X.   VIOLATIONS

Ambulance service providers found Violating any provision of these rules and regulations and its related issuances and relevant policy guidelines, and/or commission/omission  of acts by personnel  operating  an ambulance  under  this Order shall be penalized and/or its DOH-LTO suspended or revoked.

The  Health  Facilities  and  Services  Regulatory  Bureau  or  the  Regional  Office Director and/or his authorized representative(s) shall investigate complaints and verify if ambulance service provider concerned or any of its personnel is liable for an  alleged  violation.  The  HFSRB  or  R0  Director  may  order  the  preventive suspension of operation of the concerned ambulance service provider pending investigation which shall not be more than ninety (90) days.

XII. SANCTIONS AND PENALTY

Imposable  penalties  for violations  hereof  shall be in accordance  with AO. No.
2007- 0022 titled œViolations under the One-Stop Shop Licensure System for Hospitals , A.O. No. 2008-0027 known as œOne-Stop Shop System for the Regulation  of  Medical  Facilities  for  Overseas  Workers  and  Seafarers,  Non- Hospital-Based  Dialysis  Clinics  and  Non-Hospital-  Based  Ambulatory  Surgical Clinics with Ancillary Services , and related issuances or guidelines.

In  case  of  death  or  serious  physical  injury  (as  defined  by  Article  263  of  the Revised Penal Code of the Philippines)  of the patient, passengers,  pedestrians or the general public, the DOH-LTO of the ambulance service provider shall be automatically revoked if such death or injury was found or determined by the appropriate authority to be due to the negligence or misuse of the ambulance service. This is without prejudice to any criminal or civil charges or both that may be filed by the aggrieved party against the ambulance service provider.

Ambulance  service  providers  whose  DOH-LTO  has  been  revoked  shall  be prohibited from applying for another DOH-LTO as an ASP for a minimum of one (1) year.

XIII. APPEAL

Any  hospital  or  other  health  facility  aggrieved  by  the  decision  of  the  HFSRB Director or Regional Director may, within ten (10) days after receipt of the notice of decision file a notice of appeal to the Head of the Office for Health Regulation (OHR).  All  pertinent  documents  and  records  of  the  appellant  shall  then  be elevated by HFSRB or the Regional Office to the OHR. The decision of the Head of the OHR if still contested maybe brought on a final appeal to the Secretary of Health within ten (10) days after receipt of the decision from OHR. The Secretary of Health ™s decision shall be absolute and executory.

XIV.  TRANSITORY PROVISIONS

A. For application of DOH-LTO for CY 2018, ambulance service providers of both institution-based and non-institution-based  ambulances may file their applications and pay the corresponding  fees at either HFSRB or RO-RLED  until December
15, 2017.

B. Applications  filed starting  January  2018  should  follow  section  VII. A of this
Order.

XV. REPEALING CLAUSE

Provisions  from  previous  issuances  that  are  inconsistent  or  contrary  to  the provisions  of  this  Order  shall  be  deemed  impliedly  or  expressly  amended  or revoked.

XVI. SEPARABILITY CLAUSE

In the event that any provision or part of this Order is declared unauthorized or rendered invalid by any court of law, those provisions not affected by such declaration shall remain valid and in force.

XVII. EFFECTIVITY

This Order shall take effect after fifteen (15) days after its publication in two newspapers of general circulation.