New Form Guidlinedm2019 0314

Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
May
27, 2019
DEPARTMENT MEMORANDUM
No. 2019- 0)

FOR: HEALTH FACILITIES AND SERVICES REGULATORY

BUREAU (HFSRB) PERSONNEL, DIRECTORS OF CENTERS
FOR HEALTH DEVELOPMENT (CHD), _DOH-CHD
REGULATION, LICENSING AND ENFORCEMENT DIVISION
(RLED) CHIEFS, HEALTH FACILITIES AND SERVICES
OWNERS AND MEDICAL DIRECTORS AND ALL OTHERS
CONCERNED
SUBJECT: Guidelines on the use of new HFSRB Application forms as stated

in Department Memorandum 2019-0112 dated February 19, 2019
Department Memorandum No. 2019-0112 dated February 19, 2019 was issued by the
Department of Health in line with the streamlining of business processes of regulation of
health facilities and services in compliance with Republic Act No. 11032, otherwise known
as Ease of Doing Business and Efficient Government Service Delivery Act of 2018. The said
memorandum introduced two (2) simplified application forms for health facilities and services
regulation, namely: DOH-HFSRB-QOP-01-Form 1 and DOH-HFSRB-QOP-01-Form 2.
DOH-HFSRB-QOP-01-Form 1, previously known as the Application for License To Operate

shall be used in the following transactions:
1. New application for License To Operate, Certificate of Accreditation, Authority to
Operate and Certificate of Registration of health facilities and services
WN
Change in ownership
Transfer of Site
Upgrading of Hospital and free-standing Clinical Laboratory
all
AR
Renewal application of health facilities and services
On the other hand, for uniform implementation of DOH-HFSRB-QOP-01-Form 2, the

following principles shall be enforced:
1. This form shall be used by existing licensed / accredited health facilities and services
with changes not stipulated above.
2. For health facilities applying for increase in beds / increase in dialysis stations,
regulatory officers shall require the health facility owner to submit additional
documents depending on the application. In cases where the increase less than fifty is
percent (50%) of the current ABC / stations
HD and there are no alterations in the
physical structure, inspection visit may be waived for this type of application provided
that the health facility has strictly followed the stipulated capacity according to their
approved and previous Permit To Construct (PTC).
For application for change in name, regulatory officers shall require the health facility
proponent to submit the amended SEC Certificate, amended memorandum of
agreement / contract of employment of facility employees, amended forms and
standard operating procedure reflecting the new name of the health facility. Inspection
visit shall be waived for this type of application
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 71-9502; 711-9503 Fax: 743-1829 e URL: http://www.doh.gov.ph; e-mail: [email protected]
B,
4. For change / additional personnel, the health facility shall submit the following
documents:
a. Letter of intent / information addressed to the Director IV of Health Facilities
and Services Regulatory Bureau (HFSRB) or Center for Health Development
(CHD), as applicable
b. Resignation letter of personnel with receipt of Medical Director or HF owner,
if applicable.
c. Complete 201 file of personnel
i. Resume
ii. Notarized Contract of Employment / Memorandum of Agreement, if
applicable
iii. Valid PRC ID / PTR (for medical practitioners)
iv. Valid BLS / ACLS certificate, as applicable
v. Other relevant certificates of training
d. Inspection visit shall be waived for this type of application.
. For downgrading of service capability or decrease in beds / dialysis stations or

delisting of services, the health facility owner or medical director shall only submit the
duly accomplished Form 2. Inspection visit shall be waived for this type of application.
. For those health facilities and services where the inspection visit were waived,
regulatory officers shall verify the changes made via assessment during monitoring
visits or inspection visits for the renewal application.
. Health facilities shall be informed immediately of the required additional documents

after evaluation of technical staff through official letter, electronic mail, phone call or
any other means available.
. For other types of application not stated herein, inspection visit by the regulatory
officers shall be required.
All applications shall pay the corresponding processing fee upon filing. An order of payment
shall be issued to the health facility and a copy of the Official Receipt shall be submitted
together with the duly accomplished form and other documentary requirements, as applicable.
Dissemination of the abovementioned information is hereby enjoined.
Please be guided accordingly.
By the Authority of the Secretary of Health
ROLA bok . DOMINGO, MD, DPBO

Undersecretary of Health
Office of the Chief of Staff and Health Regulation Team

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Republic of the Philippines

FOR: HEALTH FACILITIES AND SERVICES REGULATORY

SUBJECT: Guidelines on the use of new HFSRB Application forms as stated

DOH-HFSRB-QOP-01-Form 1, previously known as the Application for License To Operate

On the other hand, for uniform implementation of DOH-HFSRB-QOP-01-Form 2, the

. For downgrading of service capability or decrease in beds / dialysis stations or

. Health facilities shall be informed immediately of the required additional documents

Dissemination of the abovementioned information is hereby enjoined.

Please be guided accordingly.

By the Authority of the Secretary of Health

ROLA bok . DOMINGO, MD, DPBO

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