Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

Control No. ________________________________

NOTICE OF VIOLATION

(Date)

Dear :

The result of the surveillance done by our licensing officers reveals that your health facility is offering health
services without permission or recognition granted by the DOH as mandated by law.

You are therefore directed to:

 Cease and Desist from Operating.

 Others (Please specify.)

For strict and immediate compliance.

SERVED BY:

(Printed Name and Signature of Licensing Officers) (Designation)

1.

2.

3.

4.

5.

RECEIVED BY: DATE:

(Signature over Printed Name) TIME:

(Position)

DOH-SOP02/03-Form1
Revision:02
09/17/2015
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