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Memorandum of Agreement

Memorandum of Agreement

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Published by macky symprano

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Published by: macky symprano on Mar 24, 2010
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01/21/2013

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MEMORANDUM OF AGREEMENT
 This Memorandum of Agreement executed on this _____ 
Date
- ________ at Silang Cavite, Philippines by and between.
 JULLIENNE LYING-IN AND MATERNITY CLINIC
, a business entityduly registered with the Department of Trade and Industry with businessaddress at Block 36 Lot 9 Xone 11 AFP Housing, Bulihan, Silang, Caviteand represented by the ownier / sole proprietor
RODELIZA FRENANDEZEMPIALES
, hereinafter referred to as the “
SERVICE PROVIDER
and
NAME OF HOSPITAL
, a medical and a corporate entity duly registeredin accordance with the laws of the Republic of the Philippines withbusiness at KM 43 By Pass, Silang, Cavite represented by its MEDICALDIRECTOR,
NAME OF DOCTOR/OWNER
, hereinafter referred to as the
REFERRAL HOSPITAL
;and
NAME OF OB-GYNE,
a medical practitioner (
OBSTETRICIAN-GYNECOLOGIST
) with licensed number_______, and
NAME OFPEDIATRICIAN
, a medical practitioner (
PEDIATRICIAN
) with License No. ________, both are presently affiliated at name of hospital, hereinafterreferred to as the “
PARTNER PHYSICIANS
”.WitnessethWHEREAS, Jullienne Lying-In and Maternity Clinic (SERVICEPROVIDER) is engaged in the service of providing maternity care topregnant women offering prenatal, midwife-assisted delivery and postnatal care to mothers and newborns;WHEREAS, there are onset risk cases which the SERVICE PROVIDERcan handle better with the help of professional medical practitioners afterexamination of patients and determination that they will require furtheradept medical supervision for both mothers and newborns;WHEREAS, the parties herto – the SERVICE PROVIDER and PARTNERPHYSICIANS forge a partnership concerning onset risk cases to facilitatepatients admission to the REFERRAL HOSPITAL bearing in mind the bestinterest of the mother and the unborn or newborn, as the case may be;WHEREAS, all onset risk cases handled by herein SERVICEPROVIDER and PARTNER PHYSICIANS shall be exclusively referred to theREFERRAL HOSPITAL subject to Philhealth membership of patients orbeneficiaries;WHEREAS, the trilateral relationship is meant to maximize theMaternity Care Package available to Philhealth members and theirbeneficiaries and make available its availment to a wider patient base;WHEREAS, essentially, the purpose of this Memorandum of Agreement is to extend the REFERRAL HOSPITAL’S accreditation use tothe SERVICE PROVIDER in relation to onset risk cases.
 
NOW THEREFORE, for and in consideration of the foregoingpremises, the hereinafter parties have agreed to the following terms andconditions. TERMS AND CONDITIONSArticle IDEFINITIONS OF TERMS
1.
 The Maternity Care Package is a PhilHealth Outpatient BenefitPackage that covers payment for the following services for the firstand second low-risk pregnancies, prenatal care, normal birth,routine newborn care, postpartum care, and family planning,rendered by the PhilHealth-Accredited Outpatient Clinic.2.Low-risk pregnancy with no identified risk factors. Normal birth isdefined as spontaneous is onset, low-risk at the start of the labor,and remaining so throughout labor and delivery. The infant is bornspontaneously in the vertex position between 37 and 40 completedweeks pregnancy. After birth, mother and infant are in goodcondition.3.The REFERRAL HOSPITAL is a PhilHealth-Accredited secondary ortertiary hospital equipped with state-of-the-art medical instrumentsand equipments needed for the management of obstetric ornewborn complications.
4.
 The SERVICE PROVIDER is an outpatient and a business entityknown as JULLIENNE LYIN-IN AND MATERNITY CLINIC duly accreditedby PhilHealth for the Maternity Care Package. It is non-hospitaloutpatient facility with adequate facilities and competently trainedstaff capable of providing all the maternal and neonatal services.5.REFERRAL is the process by which the SERVICE PROVIDER directsthe patient to the REFERRAL HOSPITAL due to onset risk, for furthermanagement of patient’s care.6.PARTNER PHYSICISIANs are highly qualified medical practitioners intheir own field of profession (OBSTETRICIAN-GYNECOLOGY andPEDIATRICIANS) who will provide further management of the motherand the new-born baby.Article IIOBLIGATION OF THE SERVICE PROVIDER
 
1.The SERVICE PROVIDER shall render prenatal, birth delivery,routine newborn care, and postpartum services to femalebeneficiaries during their first and second low-risk pregnancies andnormal deliveries.2.The SERVICE PROVIDER shall be available to attend to all patients atall times, especially during intra-partum.
3.
 The SERVICE PROVIDER shall be abide by/comply with theprescribed clinical pathways and practices guidelines for theMaternity Care Package.4.The SERVICE PROVIDERshall do a pregnancy risk during the firstprenatal visit of the patient.
5.
 The SERVICE PROVIDER shall provide ambulance/vehicle totransport patients to the referral hospital should an emergencyarise related to complaints on obstetric/gynecological/neonatalcases.Article IIIOBLIGATION OF PARTNER PHYSICIAN1.The PARTNER PHYSICIANS in their own judgment and directioncoordinate with the SERVICE PROVIDER of any patients whopresents with any of the EXCLUSIO CRITERIA and if necessary shallrefer the patients to the REFERRAL HOSPITAL for Obstetriccomplication and at the soonest possible time.
1.1
History of previous major obstetric/gynecologic operativeinterventions (e.g. caesarian Section, Salpingectomy for ectopicpregnancy, Oephorectomy).1.2History of three (3) or more miscarriages, or one (1) stillbirth.1.3Maternal age under 19 years old.1.4Elderly primis with maternal age of 35 years old.
1.5
Multiple pregnancy (e.g. twins, triplets, etc.,)1.6Abnormal fetal presentation (e.g. breech)1.7Placenta abnormalities (e.g. low-lying placenta, placenta previa)1.8Uterine abnormalities (e.g. myoma uteri)1.9Ovarian abnormalities (e.g. ovarian cyst)1.10History of medical conditions (e.g. hypertension, heartdisease, diabetes, thyroid disorders, obesity, moderate-serveasthma, pre-eclampsia, epilepsy, bleeding disorders)1.11Other risk factors that may arise during present pregnancy(e.g. premature contractions, vaginal bleeding), that the midwifeperceives to warrant a referral to an obstetrician / physician forfurther management.

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