Republic oithe Philippines

Department of Health
OFFICE OF TFM SECRETAR,Y

December T4,2016

DEPARTMENT MEMORANDUM
No.20l6 - 0+49

FOR ALL REGIONAL DIRECTORS" CHIEF OF HOSPITALS/

MEDICAL CENTERS/ SANITARIA. REGIONAL
BLOOD PROGRAM COORDINATORS. BLOOD BANK
IIEADS. LEAD BLOOD SERVICE FACILITIES.
PROVINCIAL HEALTH OFFICERS. PHILIPPINE RED
CROSS OFFICIALS; AND OTHERS CONCERNED

SUBJECT : Guidelines on the Issuance of Certificate of Inclusion to

Blood Services Network

Pursuant to Section 2. Declaration of Policy of Republic Act 7719, The Department of

Health is mandated to establish and organize a National Blood Transfusion Service Network
in order to rationalize and improve the provision of adequate and safe supply of blood.

All over the Philippines, blood centers and other blood service facilities within their
catchment areas are organized into Blood Service Networks, each designed to adapt to the
unique situation of their localities but nevertheless adhering to the standards that have been
set. Therefore, it is imperative that the Regional Office shall issue a Certificate of Inclusion
as part of the licensing/authorization for all Blood Service Facilities actively participating in
the network and complying with policies, guidelines and standards.

The issuance of the Certificate of Inclusion (COI) shall be subject to the following
guidelines and mechanics.

1. The final list of the blood service facilities within the Zonal Blood Services Network
(BSN) shall be submitted by the Lead Blood Services Facilities (BSF) signed by the
Chief of Hospitals/or Directors of the Lead Blood Service Facilities to the Regional
Director (RD), in attention to the Blood Program Coordinator (BPC).

2. The Regional Director will issue the Certificate of Inclusion (COD to Blood Services
Network to the blood service facilities based on the recommended list only.

3. The Regional Director will issue the Certificate of Inclusion in the Blood Services
Network to the designated Lead BSF if they perform their functions as Lead BSF.

4. The Regional Director will issue the COI if the BSF complies with the requirements
as per Blood Service Facilities Category. (see Annex A)
Bldg. No. l,SanlazaroCompound,RizaiAvenue, Sh. Cruz,Manila 1003.TrlmkLine:651-7800loc. I i08,1111,11 12,1 113 DirectL:r:'e:711-95Wor71l-9543
Far: 743-1829.LiRL: http://www.doh.gov.ph: e-mail: officeofsoh@oh.gov.ohor
5. The Regional Director will issue the COI if the BSF utilized and implemented the
National Voluntary Blood Services Program (NVBSP) Manual of Standards

a. Manual on Blood Service Facilities

b. Manual on Donor Recruitment and Counselling
c. Clinical Practice Guidelines

6. For Inter-regional Blood Services Network, the COI will be issued to the BSF by the
identified blood source of the concerned region.

7. Signatory of the Certificate of Inclusion to Blood Services Network

7.T. The certificate shall be initialled by the Regional Blood Prognm Coordinator
and approved by the Regional Director

7.2. The certificate shall be printed using the attached standard template.
(See Annex B)

For strict compliance.

PAULYN J *U"kffi,&**r, cESo rr

Secretary of Health
 ANNEX A

Checklist of Requirements of Issuance of Certificate of Inclusion into the Regional

Voluntary Blood Services Network

For Blood Collection Unit (BCU):

Requirements Means of Verification

1. Attendance to the Zonal Blood Services Network 1. Name with signature in the BSN
Meeting Attendance sheet & copy of Certificate
of
Appearance/Attendance/P articipation
2. Submission of blood reports to Blood Program 2. Blood reports submitted, collated &
Coordinator analyzed
a. Blood Monitoring reports (BM forms 0I,02
& 05) quarterly
b. Blood Safety Indicator report (BSI Sections 1
& 2) annually
3. Utilized NVBSP prescribed Donor History 3. Utilized properly accomplished DHQ
Questionnaire

Checklist of Requirements of Issuance of Certificate of Inclusion into the Regional

Voluntary Blood Services Network

For Blood Station (BS) free-standingo non-hospital based:

Requirements Means of Verification

1. Attendance to the Zonal Blood Services Network 1. Name with signature in the BSN
Meeting Attendance sheet & copy of Certificate
of
Appearance/Attendance/Participation
2. Submission of blood reports to Blood Program 2. Blood reports submitted, collated &
Coordinator analyzed
a. Blood Monitoring reports (BM forms 06,&
07) quarterly
b. Blood Safety Indicator report (BSI Sections 1,
4, & 6) annually
3. MOA with BC or Lead BSF 3. Siened MOA
4. Blood Inventory Management 4. Submitted weekly blood stocks (signed
by BS Head & as reflected in the
MOA)
5. Utilized NVBSP prescribed blood request forms 5. Utilized properly accomplished blood
(Adult &Pedia) request forms
6. Complies with recommended Maximum Blood 6. Official Receipts reflecting blood
Service fees (as per DOH AO No2015-0045 & service fees
DC # 2016-0318)
.i
, Checklist of Requirements of Issuance of Certificate of Inclusion into the Regional
Voluntarv Blood Services Network

or Blood Collection Unit/Blood Station (BCU/BS) free-standins" non-hospital based

For
Requirements Means of Verification
l. Attendance to the Zonal Blood Services Network 1. Name with signature in the BSN
Meetins Attendance sheet & copy of Certificate
of
Appearance/Attendance/P articipation
2. Submission of blood reports to Blood Program 2. Blood reports submitted, collated &
Coordinator analvzed
a. Blood Monitoring reports (BM forms 01,02,
05, 06, & 07) quarterly
b. Blood Safety Indicator report (BSI Sections l,
2,4 & 6) annually
3. MOA with BC or Lead BSF 3. Siened MOA
4. Blood Inventory Manasement 4. Submitted weekly blood stocks (signed
by BS Head & as reflected in the
MOA)
5. Utilized NVBSP prescribed forms 5. Utilized properly accomplished DHQ
a. Donor History Questionnaire (DHQ) and blood request forms
b. blood request forms (Adult &Pedia)
c. Complies with recommended Maximum 6. Official Receipts reflecting blood
Blood Service fees (as per DOH AO No2015- service fees
004s&DC#2016-0318)

Checklist of Requirements of Issuance of Certificate of Inclusion into the Regional

Voluntary Blood Services Network

I'or Hospital-based Blood Station BS) and H tal Blood Bank (HBB
Requirements Means of Verification
1. Attendance to the Zonal Blood Services Network 1. Name with signature in the BSN
Meeting Attendance sheet & copy of Certificate
of
Appearance/Attendance/P articipation
2. Submission of blood reports to Blood Program 2. Blood reports submitted, collated &
Coordinator analvzed
a. Blood Monitoring reports (BM forms 04,06&
07) quarterly
b. Blood Safety Indicator report (BSI Sections 1,
4, & 6\ annually
3. MOA with BC or Lead BSF 3. Sisned MOA
4. Blood Inventorv Manasement 4. Submitted weekly blood stocks (signed
by BS Head & as reflected in the
MOA)
5. Functional and active Hospital Blood Transfusion 5. Hospital Order for HBTC & Minutes of
Committee fiBTC) the Meetings; Blood Utilization
Review
6. Utilized NVBSP prescribed forms 6. Utilized properly accomplished DHQ
a. Donor History Questionnaire (DHQ) and blood request forms
b. blood request forms (Adult &Pedia)
c. Complies with recommended Maximum 7. Official Receipts reflecting blood
Blood Service fees (as per DOH AO No2015- service fees
0045 & DC# 2016-0318)
 Checklist of Requirements of Issuance of Certificate of Inclusion into the Regional
Voluntary Blood Services Network

For Hospital Blood Bank (HBB) with additional functions:

Reauirements Means of Verification

1. Attendance to the Zonal Blood Services Network l. Name with signature in the BSN
Meeting Attendance sheet & copy of Certificate
of
Appearance/Attendance/P articipation
2. Submission of blood reports to Blood Program 2. Blood reports submitted, collated &
Coordinator analyzed
a. Blood Monitoring reports (BM forms 01 to
08) quarterly
b. Blood Safety Indicator report (BSI Sections 1

to 6) annuallv
3. MOA with BC or Lead BSF 3. Sisned MOA
4. Blood Inventory Management 4. Submitted weekly blood stocks (signed
by BS Head & as reflected in the
MOA)
5. Functional and active Hospital Blood Transfusion 5. Hospital Order for HBTC & Minutes of
Committee (HBTC) the Meetings; Blood Utilization
Review
6. Utilized NVBSP prescribed forms 6. Utilized properly accomplished DHQ
a. Donor History Questionnaire (DHQ) and blood request forms
b. blood reouest forms (Adult &Pedia)
7. Complies with recommended Maximum Blood 7. Official Receipts reflecting blood
Service fees (as per DOH AO No20l5-0045 & service fees
DC # 2016-0318)
8. HIV and other TTIs Proficiency Training 8. Certificate of Proficiencv from RITM
Workshoo for RMTs TTI-NRL
9. Referral of tested reactive blood units for 9. Confirmatory request form & results
confirmation at RITM TTI-NRL
10. Participation in NEQAS with RITM TTI-NRL & in
10. Certificate of Participation
NKTI IH-NRL respective NRLs with Very
Satisfactory to Excellent Ratings
I 1. Subscrintion to NBBNeIS 11. Use of NBBNetS barcode sticker
 Checklist of Requirements of Issuance of Certificate of Inclusion into the Regional
Voluntary Blood Services Network

For Blood Centers (BC)

Requirements Means of Verification

l. Attendance to the Zonal Blood Services Network l. Name with signature in the BSN
Meeting Attendance sheet & copy of Certificate
of
Aooearance/Attendance/Particioation
2. Submission of blood reports to Blood Program 2. Blood reports submitted, collated &
Coordinator analvzed
a. Blood Monitoring reports (BM forms 01 to
08) quarterly
b. Blood Safety Indicator report (BSI Sections I
to 5) annuallv
3. MOA with BC or Lead BSF 3. Sisned MOA
4. Blood Inventory Management 4. Submitted weeklyblood stocks (signed
by BS Head & as reflected in the
MOA)
5. Utilized NVBSP prescribed forms 5. Utilized properly accomplished DHQ
a. Donor History Questionnaire (DHQ) and blood request forms
b. blood request forms (Adult &Pedia)
6. Complies with recommended Maximum Blood 6. Official Receipts reflecting blood
Service fees (as per DOH AO No2015-0045 & service fees
DC # 2016-0318)
7. HIV and other TTIs Proficiency Training 7. Certificate of Proficiencv from RITM
Workshop for RMTs TTI-NRL
8. Referral of tested reactive blood units for 8. Confirmatory request form & results
confirmation at RITM TTI-NRL
9. Participation in NEQAS with RITM TTI-NRL & 9. Certificate of Participation in
NKTI IH-NRL respective NRLs with Very
Satisfactorv to Excellent Ratinss
10. Subscription to NBBNetS 10. Use of NBBNeIS barcode sticker
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