Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

May 20, 2020

DEPARTMENT MEMORANDUM
No. 2020 - (22551

TO : ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES'

DIRECTORS OF BUREAUS, SERVICES, AND CENTERS FOR
HEALTH DEVELOPMENT; MINISTER OF HEALTH—
BANGSAMORO AUTONOMOUS REGION IN MUSLIM
MINDANAO: EXECUTIVE DIRECTORS OF SPECIALTY
HOSPITALS AND NATIONAL NUTRITION COUNCIL; CHIEFS
OF MEDICAL CENTERS. HOSPITALS. SANITARIAINSTITUTES
AND INFIRMARIES; PRESIDENT & CEO OF THE PHILIPPINE
HEALTH INSURANCE CORPORATION {EHILHEALTE};
DIRECTORS OF THE PHILIPPINE NATIONAL AIDS COUNCIL
QENACQ AND TREATMENT AND REHABILITATION CENTERS
gTRng; AND ALL OTHERS CONCERNED
SUBJECT : Interim Guideline on Local Travel Ban Exemption(s) of Persons with
Medicallv NecessaryReasons in the COVH)—19 Pandemic

I. BACKGROUND

Last December 2019, a novel type of coronavirus, later named as severe acute
respiratory syndrome coronavirus 2 (SARS-CoV—2), caused a pneumonia-like outbreak
which was later known as coronavirus disease (COVID—19).1 The Department of Health
(DOH) has reported its first case of COVID—19 on January 30, 2020 and confirmed the
first local transmission on March 7, 2020. Five days later, the World Health Organization
(WHO) made an assessment that COVID-19 can be characterized as a pandemic.2
The COVID-19 pandemic has caused unprecedented challenges in the health care
system and on the social and economic aspects of life. Since then, there has been an
increasing number and spread of cases of COVID-19 and the occurrence of sustained
local transmission in the National Capital Region (NCR) and in some parts of the country.
This has led to the imposition of enhanced community quarantine (ECQ) and stringent
social distancing measures over the entire Luzon by the National Government through a
Memorandum from the Executive Secretary dated March 16, 20203 restricting people’s
movement and prohibiting mass gatherings and transport through public conveyance.
The restriction in the populace's movement prescribed people to stay in their homes and
can only go outside for basic needs such as food, medicines and other things needed for
sustenance. On May 12, 2020, IATF Resolution No. 35 outlined extension of quarantine
measures until May 31, 2020 with areas designated either under Modified ECQ or
Modified GCQ categories.

1ht_tps://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-g1_1idance/naming-the—coronavirus-disease-
1covid-2019)-and-the-virus-that-causes-it
2
h s://www.who.int/news-roorn/detaiI/Z7-04-2020-who-timeline---CoViD-19
3
hmJ/wwwcovidl 9.gov.ph/v_vp-content/uploads/2020/03/OP-MEMO-FRM-ES.pdf

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila 0 Trunk Line 8651-7800 local 1108, 1111, 1112, 1113
Direct Line: 8711-9502; 8711-9503 Fax: 8743-1829 0 URL: http://www.doh,gov,ph; e-mail: fiduque@doh.gov.ph
 In order to facilitate movement and unhampered access of individuals to important
health facilities and services, this issuance shall guide health facilities, health
professionals and health care providers, other government agencies and offices involved
in the implementation of quarantine measures in the provision of exemption from the
local travel ban and movement restriction to and from health facilities for persons with
medical considerations.

II. NON-EMERGENCY ESSENTIAL HEALTH OR HEALTH-RELATED

SERVICES
Persons that seek or provide non-emergency essential health or health—related
services are deemed categorized as essential travel. They are hereby EXEMPTED from
the local travel ban, interzonal and intrazonal restriction when travelling to and from
health facilities (public or private), regardless of community quarantine status, provided
that a health pass, with associated health-related documents, is presented to concerned
officials. Persons seeking these services are the following, but not limited to:

1. Patients enrolled in the DOH cancer medicine access program;

Patients, adults, and children, scheduled for chemotherapy;
3. Patients with end-stage organ diseases and those with end-stage renal disease
(ESRD) requiring hemodialysis (I-ID) and/or securing appropriate blood
products for transfirsion“;
4. Patients on peritoneal dialysis (PD) on their scheduled PD claims from
hospitalsS;
5. Kidney transplant candidates requiring emergency dialysis access and liver
transplant candidates with deteriorating status with no options for bridge
therapies6;
6. Transplant recipients for post-transplant follow-ups and those needing
emergency care due to post-surgical complications and co-morbidities7;
7. Drug—Susceptible Tuberculosis (DSTB) and Multidrug-Resistant Tuberculosis
(MDR TB) patients on Directly Observed Treatment Short Course (TB-
DOTS);
8. People Living with HIV (PLHIV) for all age groups on antiretroviral therapy
(ART);
9. Patients on schedule hematologic therapies for hemoglobinopathies (e. g. iron-
chelation treatment or transfusion for thalassemia) or hemophilia (e. g. factor
VIII or IX concentrate, etc.);
10. Patients with rheumatologic or autoimmune conditions requiring
immunotherapies;
11. Patients with medical implants requiring re-assessment with scheduled
replacement or removal;
12. Pregnant women with have non-emergency conditions requiring obstetric
evaluations for maternal and fetal well-being;

4PSN Interim Guidelines in the Prevention, Control and Management of COVID-l9 Infection in Hemodialysis Facilities.
Philippine Society of Nephrology.11 March 2020.
5
National Kidney and Transplant Institute. “Pabatid Mula sa CAPD.”
littps://www.facebook.com/nkti.govph/posts/lOl58652019058606 27 March 2020. Facebook update.
6
Official Statement by the Philippine Society for Transplant Surgeons on the Practice of Solid Organ Transplantation and
Transplant-Related Services during the n—COVIDI9Pandemic. Philippine Society of Transplant Surgeons. 18 April 2020.
 13. Pregnant women, infants, children, adolescents, and other high-risk
age groups
or occupational groups requiring immunization for vaccine-preventable
diseases;
14. Infants, children, and adolescents, with physical, language, developmental
and/or behavioral disabilities or related conditions requiring physical therapy,
occupation therapy, speech therapy or other related interventions. Adults with
similar disabilities or conditions requiring the same, shall likewise apply;
15. Adults and pediatric patients with cardiovascular, cerebrovascular, neurologic,
rheumatologic, or orthopedic, and other related conditions requiring physical
and rehabilitation medicine interventions;
16. Adult and pediatric patients requiring laboratory procedures and diagnostic
imaging tests as part of telemedicine consult;
17. Private duty nurses, midwives and caregivers who will take care of chronic or
debilitated patients;
18. Physical therapists, occupational therapists and speech therapists who will
provide home-based rehabilitation interventions to their patients;
19. Phlebotomists or medical technologists, including the drivers of mobile
laboratories, who will obtain laboratory specimens fiom patients who are
unable to go to and from standalone or hospital- based diagnostic laboratories
due to chronic or debilitating conditions.
20. Family members who are doing errands to facilitate or get financial support
for medical expenses.

III. EMERGENCY CONDITIONS

A. Persons that seek or provide emergency health services are hereby deemed
categorized as essential travel, even without a health pass. They are hereby
EXEMPTED from the travel ban and, interzonal and intrazonal movement
restriction when travelling to and from health facilities (public or private), without
the need of a health pass.

Emergency conditions are classified based on the urgency and nature of these
emergency conditions (i.e. conditions that may lead to loss of life, limb, senses, or
functionality if not addressed urgently). Adults and the parents of children who
might be affected during these emergencies may directly coordinate with barangay
officials and members of the Barangay Health Emergency Team (BI-lERT) to
provide transportation assistance. Likewise, local government unit ambulance or
conduction vehicles may be used to transport affected patients.

Persons seeking the following, but not limited to, emergency services shall be
exempted from the travel ban:
1. SURGICALCONDITIONS

a. Trauma (e. g. fractures, burns, scalds or blast injuries, head trauma, other
vehicular or pedestrian-related injuries, etc.)
b. Acute ocular emergencies (acute angle closure glaucoma, retinal
pathologies, mechanical injury to the globe, chemical injury)
9.0
Acute airway or foreign-body obstruction
Acute abdomen
6. Acute urinary colic or obstruction
 f. Surgical conditions infections requiring drainage
g. Other emergency or surgical conditions that may require urgent care or
assessment with medical certificate from attending physician or surgeon
2. OBSTETRIC CONDITIONS

Ectopic pregnancy
9‘ Uncontrolled hypertensive disorders in pregnancy (e.g. pre-eclampsia,
etc.)
9.0
Eclampsia
Women in preterm labor
Women in latent stage or active stage of labor
Obstructed labor
Placenta previa in hemorrhage
Retained placenta with hemorrhage
*‘PFWWQ

Postpartum hemorrhage
Postpartum medical complications (febrile illness, chest heaviness,
difficulty of breathing, etc.)
F Other emergency or obstetric conditions not listed above that may
require urgent or emergency assessment with medical certificate from
the attending physician, obstetrician-gynecologist, midwife, or nurse-
midwife
3. DENTAL CONDITIONS

Uncontrolled bleeding from the oral cavity

Cellulitis with intra- or extra-oral swelling that may compromise
patient’s airway
Unstable maxillofacial fracture or trauma that may compromise
patient’s airway
Other emergency or surgical conditions not listed above that may require
urgent or emergency assessment with medical certificate from the
dentist

4. MEDICAL CONDITIONS

a. Myocardial infarction (heart attack) or acute hypertensive emergencies

b. Respiratory distress (airway obstruction, severe pneumonia, or
respiratory failure)
Acute neurologic emergencies (seizures, stroke, paralysis, loss of
consciousness, confusional states, etc.)
Acute exacerbations of chronic conditions (chronic obstructive
pulmonary disease, asthma, eczemas or derrnatitides)
Acute anaphylactic or severe allergic reaction (e.g. Stevens—Johnson
Syndrome, toxic epidermal necrolysis, etc.)
Uncontrolled chronic conditions requiring medical evaluation (e.g.
hypertension, diabetes, congestive heart failure, etc.)
Unexplained bleeding from the body (hemoptysis, hematemesis, or
hematochezia)
Febrile neutropenia after chemotherapy
 Febrile illness unresponsive to antipyretic or without improvement
despite antibiotic therapy
Chemical poisoning through ingestion, inhalational or contact exposure
Animal bites
Drowning or near-drowning cases
.Acute psychiatric conditions with suicidal ideation, violent or
aggressive behavior
Other emergency conditions not listed above that may require urgent or
emergency assessment with medical certificate from the physician or
internal medicine specialist

5. PEDIATRIC CONDITIONS
Apart from the selected surgical, dental, and medical conditions stated
above, the following pediatric conditions require urgent care and emergency
evaluation

Neonatal conditions suggestive of sepsis or infection (i.e. poor suck,

poor cry or activity, infected umbilical cord stump, etc.)
b. Neonatal jaundice requiring phototherapy and admission
Neonatal respiratory distress syndrome (e. g. due to prematurity,
meconium aspiration, etc.)
Intrapartum-related injuries (e. g. hypoxic-ischemic encephalopathy)
requiring neonatal intensive care
rm
Hemorrhagic disease of the newborn
Birth trauma or injury requiring specialized orthopedic care
qo Acute febrile illness of 2 to 3—day duration that is unresponsive to
antipyretics or prolonged fever of unknown origin
Parr
Severe pneumonia and other respiratory distress
Diarrhea or gastroenteritis unresponsive to oral rehydration with signs
of dehydration '

vex——
Altered alertness or wakefulness with or without localizing signs
Critical congenital heart disease in failure requiring pediatric cardiology
management
Congenital surgical conditions (diaphragmatic hernia, gastroschisis,
omphalocele, imperforate anus, etc.)
. Burn or scald injuries requiring hospital admission and referral to a Burn
Umt
Cleft lip or cleft palate that may impair breastfeeding or other forms of
infant feeding methods
Infants or children who have severe acute malnutrition (SAM) who
failed the appetite test, and with or without edema, and/or MAM patients
with bilateral pitting edema requiring referral to inpatient therapeutic
center (ITC) for management of acute malnutrition.
Other emergency conditions not listed above that may require urgent or
emergency assessment with medical certificate from the physician or
pediatrician

Operators of commercial emergency medical service providers with ambulance

conduction are automatically exempted in conveyance of sick patients. The same
shall apply to ambulances of government and private health facilities transportlng
the same.
 Individuals or families who will be using their private vehicles to transport their
sick patients may go directly to the health facility and are advised to bring their
duly-issued Permit to Leave Premises (PLP) ID card, Barangay Quarantine Pass
(BQP), or its equivalent.

IV. HEALTH PASS

A. As proof of exemption from the travel ban and restriction of movement, a
HEALTH PASS (HP) shall be presented by the concerned person at every
checkpoint while travelling to and from the health facility.
To standardize the form and substance/content of the Health Pass, the prototype
(Refer to Annex A) shall be disseminated through the Centers for Health
Development to various health facilities.
The Health Pass shall be issued by the health facility to the person concerned and
shall bear the signature of the head or chief of the health facility.

The following information shall be indicated in the Health Pass:

1. Name of the Patient

2. Sex
3. Age
4. Address
5. Name of the Attending Physician / Doctor / Dentist / Midwife
6. Schedule of visit/s to the health facility
The Health Pass shall be free of charge. This shall not be transferred to other
individuals.
The Health Pass shall be valid only on the date of issuance until the ECQ/GCQ
period is officially lifted.
For persons who DO NOT have a Health Pass or travelling for the first time to
HEALTH FACILITIES FROM THEIR PLACE OF RESIDENCE/HOME:
1. Request the Barangay Health EmergencyResponse Team (BHERT) to provide
appropriate transport services to the persons needing medical attention.
2. EXCEPT in serious or emergency situations, persons seeking care or
consultation who do not have a Health Pass shall present the following for
verification purposes to be allowed to pass through checkpoints in ECQ/GCQ
areas.

a. a medical certificate issued by his/her attendingphysician/dentist or health

care provider; OR
b. existing health cards (e.g., outpatient cards in cancer patients); AND
c. a valid government-issued identification card (If the person does not have
a government-issued ID card, a community-issued Permit to Leave
Premises (PLP) ID card/Barangay Quarantine Pass (BQP) or its
equivalent can also be presented along with the medical certificate).
3. For persons who do not have a medical certificate issued by an attending
physician/dentist/midwife or those travelling for the first time to ECQ areas
 outside of their place of residence or catchment area, the following are
presented:
a. a medical certificate issued by the local health office (City or Municipal)
within the place of residence; OR
b. existing health cards (e.g., outpatient cards in cancer patients); AND
c. a valid government—issued identification card.
4. For persons who do not have all the items required above (e.g. a child for
routine immunization) the quarantine pass will suffice.
H. For persons travelling from HEALTH FACILITIES TO PLACE OF
RESIDENCE/HOME:
1. Persons seeking care or consultation shall secure a Health Pass from the health
facility and this shall be presented together with a valid government-issued
identification card to every checkpoint when travelling from the health facility
to the place of residence.

CONTINUED ADOPTION OF RISK-BASEDPUBLIC HEALTH STANDARDS

Consistent with the implementation of public health measures and the overall
infection and prevention control (IPC), persons with medical conditions travelling to and
from health facilities shall at all times practice and observe respiratory etiquette, social
and physical distancing, mandatory wearing of mask and proper handwashing and
hygiene using water and soap or 70% alcohol-based sanitizer to curb the transmission of
COVID-l9.

For further inquiries and clarifications, the following may be contacted:

o DILG/DOH Hotline :
(632) 894-COVID (26843)
0 For PLDT, Smart, Sun and TNT Subscribers ,2 1555
0 DOH Call Center : (632) 8651-7800
Online: https://www.doh.gov.ph/contact
Email: callcenter@doh.g0v.ph
For strict compliance.

QUE in, MD, MSc

of Health
 Annex A. Sample Health Pass

Control No.
__
Control No.

Name of Health Facility

FRONT

pass the qu ekpcoint on the

dates indicated at the back.

Signature of the Chief of Health Facility

BACK Personal Information
Name
Age
Sex
Address
Medical Services Required

Indicate the Schedule of visits to

the health facility