PHFSA

POST REGISTRATION
CHECKLIST
PURPOSE OF INSPECTION

• POST REGISTRATION

• SURVEILLANCE

• ENFORCEMENT
 PART 1

DOCUMENTS INSPECTION
 ORGANISATION
&
MANAGEMENT

• MANDATORY REQUIREMENTS

• OTHER REQUIREMENTS
 EMERGENCY CALL
INFORMATION
In the event of emergency the relevant contact telephone numbers are
:
DR MMA : 012-1234567
HOSPITAL IPOH : 05-2533333
IPOH SPECIALIST HOSPITAL : 05-2418777
HOSPITAL FATIMAH : 05-5455777
HOSPITAL PANTAI PUTRI : 05-5484333
BALAI POLIS PEKAN BARU : 05-2424222
FIRE BRIGADE/BOMBA : 05-5499111
EMERGENCY FIRE/POLICE/AMBULANCE : 999

Ambulance may be called from Hospital Ipoh/Ipoh Specialist Hospital

or any of the other hospital listed above.
 ORGANISATION CHART
Person In Charge (PIC)
DR MMA

Administrator Accounts
PN SITI MS LIM

Clinic Nurse Clinic Nurse Clinic Nurse Clinic Nurse Clinic Nurse
MS CATHERINE MS PAULINE CIK IDA CIK NOR MS JENNY

Janitor
PN YATI
 DUTY ROSTER
Doctor : Dr MMA is the ONLY doctor
available at this clinic. He will be on
call every day at the clinic operating
hours, EXCEPT when he is called
away for Emergency (House-Calls)

Clinic Nurses : All the nurses (Ms Catherine, Ms

Pauline, Cik Ida, Cik Nor and Ms
Jenny) will be on call at the clinic
during the clinic operating hours.
 STAFF REGISTER
NAME I/C NO TEL NO ADDRESS

Dr MMA 000120-8-5530 012-1234567 723 Jln Bintang

Taman KL
Ms Lim 123500-08-7750 012-0012345 50 Laluan
Bendahara KL
Pn Siti 012300-08-5520 012-1230000 14 Lebuh 5 Tmn
Bintang 4 KL
Ms Catherine 001133-03-2230 012-3044500 32 Jalan Tasek
Klang
Cik Ida 220000-01-1234 012-5400600 54 Tmn Tasek
Kl
Cik Nor 001130-01-3200 012-1230040 10 Jln 11 Tmn
Orkid KL
 STAFF REGISTER
NAME I/C NO TEL NO ADDRESS

Ms Jenny 213000-01-4500 012-3006000 21 Jln Tasek 4

KL

Pn Yati 450100-01-7800 012-6005050 123 Jln Kuala

Ipoh
POLICY & PROCEDURE

• MANDATORY REQUIREMENTS

• OTHER REQUIREMENTS
 CLINIC POLICY
Organisation : Klinik MMA
546-548 Jalan Bintang
Taman Orkid
45300 Kuala Lumpur

Resident Doctor : The Resident Doctor is DR MMA

MBBS (Malaya)
He provides consultation,
diagnostic and treatment services
as well as medical advice to
patients.
 CLINIC POLICY
Responsibilities of the Doctors :

• The doctor in charge is responsible for the overall

management of the patients.

• He is responsible for the initiation of treatment of the

patient, including the administration of injections.

• He will supervise the dispensation of pharmaceutical drugs.

 CLINIC POLICY
Services provided :

• Only outpatient treatment and services are provided.

• Patients are seen on a “first come first serve” basis.
• Diagnostic and Imaging services provide :
√ Urine pregnancy test
√ Abdominal/pelvic ultrasound
√ Blood screening tests
 PROCEDURE OF PATIENTS
REGISTRATION, ATTENDANCE AND
REFERRALS

Registration/Attendance :
• All patients must be registered in the attendance sheet.
• The following details have to be entered into each
patient’s treatment card :
√ Name
√ Sex
√ Address
√ Identity Card No.
√ Contact Tel. No/s if available
 KLINIK MMA
Registration Sheet
NO PATIENT’S I/C NO ADDRESS
NAME
FOLLOW UP PATIENT REGISTER

DATE REG NO NAME I/C NO SIGN

 REFERRALS
• Patients will be referred to a doctor or hospital of his/her
choice.

• Patients who have to be referred to a hospital for any acute

illness or emergency are advised to go to a hospital using
their own transport as this will be faster. However, upon
request, or if the need arises, an ambulance can be arranged
from Hospital Ipoh or Ipoh Specialist Hospital. Every effort
will be made to inform the doctor on call at the hospital to
which the referral is being made.

• Patients with unstable vital signs will be given all

appropriate treatment possible and will be transferred to the
hospital of their choice by ambulance.
 REFERRAL FORM
KLINIK MMA 546-548 Jalan Bintang
Taman Orkid
DR. MMA MBBS (Malaya) 45300 Kuala Lumpur
Tel no: 03-66053210
Fax no: 03-66545460
PLEASE BILL CLINIC / PATIENT / COMPANY
C No: 6011

Date :

To:
…………………… Dear Dr. ……………………………
……………………
………………….. RE……………………………………
……………………
I/C No:………………………………

AGE:…………….SEX:……………

COMPANY:………………………..
I wish to refer this patient to your.

Patient’s complaint / history :-

……………………………………………………………………………

……………………………………………………………………………

………………………………………………………………………….....
Thank you.
Yours faithfully,

……………………………….
 INCIDENT REPORTING
• A report of an adverse event, e.g. death
happening in the clinic.

• The person in charge to document all

details of incident including reporting the
event.
 INCIDENT REPORT FORM
• Name of Clinic : ______________________________
• Address of Clinic : ______________________________
• Date and Time of Incident : ___________________________
• Nature of Incident : __________________________________
__________________________________
__________________________________
• Action : __________________________________
__________________________________
• Date of Report Sent : _________________________________
• Name of Person Pending Report : ______________________
 INFECTION CONTROL
• All notifiable diseases are to be recorded in a
Notifiable Infection Disease Register.

• All notifiable diseases shall be reported to the

relevant authorities in the infectious disease
notification form.
GENERAL PROVISIONS
FOR STANDARDS OF
PMC OR PDC
STANDARDS FOR
OUTPATIENT
FACILITIES AND
SERVICES
 TRANSPORTATION OF
LABORATORY SPECIMEN :
∗ All specimens are to be collected in the respective containers supplied
by the laboratory.

∗ The collected specimens must be properly labeled.

∗ All specimens are to be collected/sent to the laboratories in plastic

bag.

∗ All specimens must be accompanied with a duly filled request form.

∗ All specimen are to be sent to the laboratories soon after collection.

∗ All records of dispatch of specimen to be properly recorded and

maintained
 FEE SCHEDULE
• A copy of the Fee schedul e
is ke pt in the clini c for the
pati ent’s ref erence
 Klinik MMA
546-548 Jalan Bintang
Taman Orkid
45300 Kuala Lumpur

CONSE NT F OR M F OR OPE R AT I ON / PR OCE D UR E

I…………………………………………………………..….…NRIC…………………………….……………Residing at

………………………………………………………………………………………………………..………………………at present, a patient in Klinik Manalan (M)

Sdn. Bhd. , No. 723-725, Jalan Kuala Kangsar, Ipoh, hereby authorise Dr……...…………………..…. (and whomever he may designate as his assistant)
to perform ……………..……………...…………..…………………………… and such additional procedures and operations as are considered necessary on
the basis of findings during the course of the above mentioned operation / procedure. I further hereby give consent to the administration of
Anesthesia as may be deemed necessary for the performance of the above mention operation / procedure. I hereby certify that, I have been fully
explained, the nature of the operation / procedure in my OWN LANGUAGE and fully understand the above authorization.

………………………………….. ……………………………….
Signature of Patient Signature of Witness

Date :………………………. Date :……………………

……………………………………
Signature of Doctor

Date :………………………..
 PATIENT GRIEVANCE MECHANISM PLAN :
Mechanism :
∗ Any patient with a grievance will be advised to discuss his grievance
with the doctor.

∗ If after this, and the grievance still remains unresolved, the patient is
then requested to lodge his grievance by filling the Grievance Report
Form which should be acknowledged by the doctor.

∗ An investigation is then conducted as soon as possible and the findings

are to be recorded in the Grievance Investigation Report Form.

∗ The complainant is then informed of the outcome of the investigation.

∗ If this fails to resolve the matter, the doctor shall arrange a mediator
who is agreeable to both parties.

∗ If this fails too, then the matter is referred to the Director General for
adjudication.
 GRIEVANCE REPORT FORM
Name of Patient : ______________________________
I.C. No : ______________________________
Date : ______________________________
Nature of Grievance : ______________________________
______________________________
______________________________
Received by (staff) : ______________________________
______________________________
______________________________
 GRIEVANCE INVESTIGATION
REPORT FORM
Clinic : ______________________________
Address : ______________________________
Name of Patient : ______________________________
I.C. No : ______________________________
Date : ______________________________
Nature of Grievance : ______________________________
______________________________
______________________________
Findings of Investigation : ______________________________
______________________________
______________________________
Result : ______________________________
______________________________
 PROVISION OF MEDICAL
REPORTS

∗ Upon a wr itten request by a pati ent , the

cl ini c wi ll issue a medi cal report. A
pay ment may be requi red to prepar e the
sai d medical repor t
 DISASTER PREPAREDNESS PLAN
∗ In the event of a di saster occurri ng in
the cl ini c or in the vici ni ty of the cl ini c,
a disaster acti on pl an wi ll be acti vated : -

- An area in the clinic will be prepar ed to

receive d the patient s
- Basic f irst aid will be provided immedi at ely
- Basic emerg ency car e equipme nt wil l be
mobilised to t his ar ea
- The near est hospital is to be inf ormed to
pr epare the a rrival of t he patient s.
- App ropriat e recor d of the referr ed pati en ts to
be kept
 STAFF IDENTIFICATION
• ALL Cl inic Staf f wi ll wear
identi ficati on na met ags
duri ng cli ni c hours
 BILLING PROCEDURE

• The medi cal bi ll and

itemi zed recei pt is to be
gi ven to the pati ent, if
requested
 INFECTION CONTROL

• MANDATORY REQUIREMENTS

• OTHER REQUIREMENTS
 SPECIAL
REQUIREMENTS FOR
EMERGENCY CARE
SERVICES

• MANDATORY REQUIREMENTS

• OTHER REQUIREMENTS
 PART II

FACILITIES
AND
SERVICES INSPECTION
 COLD CHAIN MAINTENANCE
∗ Dedicate this refrigerator only for storing vaccines
√ Do not store drugs, specimens, reagents, food or drinks in
this refrigerator

∗ Locate your refrigerator appropriately

∗ Place your vaccine in the appropriate area

√ Do not store vaccine in door shelves or freezer, or in the
compartment directly under the freezer. Place thermometer
in centre of refrigerator, so that it can be read without
moving the thermometer.
 COLD CHAIN MAINTENANCE
∗ Maintain refrigerator temperature at 2ºC to 8ºC the time
√ Do not open the refrigerator unnecessarily. If your
refrigerator requires defrosting, do it at least monthly.

√ Have an action plan in the event of power failure.

 COLD CHAIN MAINTENANCE

* Monitor the refrigerator temperature daily

√ Use dial or minimax thermometers
√ Chart the refrigerator temperature at least once every
working day. If temperature is persistently below 2ºC to 8ºC
:
i) check refrigerator regulator
ii) set regulator higher if above 8ºC
iii) set regulator lower if below 2ºC
iv) if this does not work, defrost your refrigerator
 SPECIAL
REQUIREMENTS FOR
PHARMACEUTICAL
SERVICES

• MANDATORY REQUIREMENTS

• OTHER REQUIREMENTS
 SPECIAL
REQUIREMENTS FOR
RADIOLOGICAL OR
DIAGNOSTIC IMAGING
SERVICES
• MANDATORY REQUIREMENTS
• OTHER REQUIREMENTS
 LEVEL OF COMPLIANCE
• MORE OR EQUIVALENT TO 75% - SAFE

• 50 - 74% - WARNING WITH 3 MONTHS PERIOD OF

RECTIFICATION

• < 50% - PENDING REVOKE COR (RECOMMEND

TO MOH & AWAITING DG’S DIRECTIVES)