Republic of the Philippines

Province of South Cotabato

MUNICIPALITY OF TAMPAKAN
Office of the Municipal Mayor
Telefax: 227 – 1001/1067
E-mail Address: lgutampakan2019@gmail.com

MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THIS PRESENTS:

This Memorandum of Agreement (MOA) is made and entered into by and between:

The Municipal Local Government Unit (LGU) of Tampakan with office address at Poblacion, Tampakan,
South Cotabato represented herein by its Municipal Mayor, LEONARD T. ESCOBILLO, RN, hereinafter
referred to as the “FIRST PARTY”;

and

DR. ROSEMINA L. QUIRAPAS, DOH Accredited Physician, with Clinic at 2nd Floor, Dr. Arturo P. Pingoy
Medical Center, Koronadal City, South Cotabato, a General Psychiatrist under the laws of the Republic of
the Philippines, and hereinafter called as the “SECOND PARTY”:

WITNESSETH:

WHEREAS, the FIRST PARTY is a Municipal Local Government and a service provider of
Dangerous Drug Abuse Prevention and Treatment Program such as but not limited to General Intervention
(GI) and Community-Based Drug Rehabilitation Program (CBDRP);

WHEREAS, the SECOND PARTY is a trained psychiatrist who specializes in mental health,
including substance use disorders;

WHEREAS, the FIRST PARTY desires to refer PWUDs who are enrolled in the General
Intervention (GI) and Community-based Drug Rehabilitation program (CBDRP) needed referral, further
evaluation and treatment of a psychiatrist after being assessed and evaluated on Drug Dependency
Examination (DDE) by an accredited DDE Physician;

WHEREAS, the SECOND PARTY will be providing psychiatric evaluation and treatment;

WHEREAS, the FIRST PARTY should refer Persons Who Used Drugs (PWUDs) with psychiatric
problem for further evaluation and treatment;

WHEREAS, the SECOND PARTY should issue psychiatric clearance to the PWUDs with
psychiatric problem prior to the enrolment in the Community-Based Drug Rehabilitation Program (CBDRP).

WHEREAS, the FIRST PARTY recognizes the capacity of the SECOND PARTY as psychiatric
provider for the PWUDs provided that the legalities and technicalities between the two parties are always
charted.

NOW, THEREFORE, in consideration of the mutual interests described above, the parties agree to
work together in the following manner.

A. The FIRST PARTY is expected to do the evaluation by the Municipal Health Officer and will
facilitate the referral after being assessed and evaluated on Drug Dependency Examination (DDE)
by an accredited DDE Physician;

B. The SECOND PARTY is expected to provide mental health assessment or evaluation and
treatment regimen to PWUDs;
 C. TERMS AND CONDITIONS

 The FIRST PARTY shall refer PWUD who needs psychiatric evaluation through an
endorsement letter / referral signed by the Municipal Health Officer and will be scheduled for
evaluation based on the availability of the SECOND PARTY at her Clinic.

 The referred PWUD (patient) shall settle outright professional fee through cash payment to the
SECOND PARTY for the services rendered.

 An annual partnership review shall be needed to ascertain that proper management has been
followed. Either party may terminate this agreement for any reason whatsoever upon the giving
of thirty (30) days prior notice to the other party and the final liquidation of any amounts that
may remain outstanding as of the date notice of termination was first given.

The agreement shall take effect upon signing of all parties for a term of one year, and thereafter it
shall be renewed for successive period of one year, unless sooner terminated as herein provided.

IN WITNESS WHEREOF, the parties here have affixed their respective signatures on this _____
day of ___________________________ 2023 in Tampakan, South Cotabato.

For MLGU Tampakan, South Cotabato

Represented by:

LEONARD T. ESCOBILLO DR. ROSEMINA L. QUIRAPAS

Municipal Mayor Psychiatrist
FIRST PARTY SECOND PARTY
ID No.: 942-407-880 (TIN) PRC ID No.: 0088575
Issued on: 09/27/2010 Issued on: 09/09/1997

Signed in the presence of:

DR. GILLIAN JOY P. TEDERA

Municipal Health Officer
PRC ID #: 0132164
Date Issued: 09/11/2015