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TABLE OF CONTENTS

CHECKLIST OF REQUIREMENTS for KonSulTA

GENERAL REQUIREMENTS

A. Provide Data Record- completely filled out


B. Performance Commitment (PC)- Revision 3, signed by authorized representative
C. Updated Certified True Copy of DOH License to Operate (PCF, Hosps, ASC, FDC,
etc.) as applicable
D. Proof of Payment of Accreditation Fee
E. Photo of Signage
F. Updated Philhealth premium contribution of employees

SELF ASSESSMENT TOOLS:

G. Annex B: Konsulta Self-Assessment Tool


H. Annex B.1: Health Human Resources Survey Tool
a. Attached copy of updated PRC License
I. Annex B.2: Checklist of Philhealth Konsulta Drugs and its Preparations
J. Annex B.3: Checklist of Philhealth Konsulta Laboratories and Diagnostic

CERTIFICATION OF SERVICE DEKIVERY SUPPORT

K. a. Annex D. 1 Certification of Se4rvice Delivery Support (Laboratory and Diagnostic


Services)
b. Annex D. 2 Certification of Service Delivery Support (Medicines).

ADDITIONAL REQUIREMENTS:

L. Proof of presence of fully functioning ECG machine and peripherals


M. Training Certificate on Direct Sputum Smear Microscopy (DSSM)
N. Schedule of duties/ clinic hours
O. Emergency preparedness Plans (Exit and evacuation plans, presence of fire
extinguisher, etc.)
P. Adequate and appropriate information materials (flyers, brochures, posters, audio
visual presentation, etc.)
Q. Non-disclosure Agreement

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