ISSUANCE OF INITIAL LICENSE TO OPERATE/ AUTHORITY TO OPERATE 1-3 OSS HOSPITAL/INFIRMARY/BIRTHING/DENTAL LABORATORY/GENERAL CLINICAL LABORATORY AND BLOODSTATION Steps Process Documents Needed Person Responsible Dura tion 1 Secures application form and Facility checklist of requirements owner/Representative 2 Explains the process of Regulatory application and its requirements Officers/Secretariat 1.Letter of Intent to Apply for a 3 Submits accomplished form and Facility LTO/ATO other documentary requirements Owner/Representatives 2.Copy of Approved Permit to With 4 Receives, log application Secretariat/Officer of Construct for hospital , infirmary in the Week and birthing The 5 Reviews/Evaluates completeness Hospitals/Infirmary/ 3.Notarized Application Form Day of documents and other Birthing: (acknowledgement) requirements Leah Sungcad / 4.List of Ancillary Services for *If incomplete, returns to Clinical Lab/Blood hospital applicant Station: Roldan.Cubillo/ 5.Copy of Valid PRC ID *If complete, issues order of WTL: Mae Flores/ 6.Notarized Contract/Proof of payment Dental Lab: Dr. Edsel Employment Roseus L. Villas/ 7.Certificate of Trainings/Board Officer of the Week Certificate 6 Proceeds to Cashier for payment Facility 8.Copy of Certificate of Philippine and submits photocopy of official Owner/Representatives Society of Pathologist for clinical receipt lab 7 Submits photocopy of official Facility 9.SEC/DTI for private and Board receipt Owner/Representatives Resolution for government 10.Quality Manual / SOP 8 Schedules and conduct of ocular Regulatory 11.Certficate of Assurance/MOU inspection Officer/Officer of the for birthing 12.List of Personnel Week 13.List of Equipments/Instrument Regulatory 9 Informs facility of inspection 14.MOA/Certificate for affiliation finding (Issues Summary of Officer/Officer of the With 15. Certificate of Compliance for Evaluation, Post-Inspection Week in X-ray and pharmacy (Hospital & Evaluation) (thir Infirmary) *If no deficiencies, application is ty) 16.Health Facility Geographic recommended for approval 30 Form (Location Map) 10 Prepares, initials, signs License to Regulatory Officer days 17.Photographs of the exterior Operate (LTO) / Certificate of Dr. Josie Ann Danes(SH) and interior of the health facility Accreditation (COA) Dr. Guy Perez (OIC) 18.Floor Layout for Blood Station, Dr. Sophia M Clinical and Dental Prosthetic Lab .Mancao(ARD) 19.Certificate of Inclusion for Dr. Jaime S. Blood Station Bernadas(RD) 11 Releases License to Operate (LTO) 20. Recent 2X2 ID Picture of Records Section (Mr. Owner, Dentist and/or Dental / Authority to Operate (ATO) Joel Saquilon/Ms. Edith Technologist for Dental Yu) Prosthetic Laboratory 21. Copy of Official Receipt Payment

Fee

REFER TO PAGE THRE E (3)

ISSUANCE OF RENEWAL LICENSE TO OPERATE/CERTIFICATE OF ACCREDITATION/AUTHORITY TO OPERATE 2-3 OSS HOSPITAL/INFIRMARY/BIRTHING/DENTAL LABORATORY/ GENERAL CLINICAL AND WATER TESTING LABORATORY/ BLOOD STATION STE PROCESS Documents Needed Person Duration Fee PS Responsible 1 Submits accomplished renewal 1.Notarized Application Form Facility application form and other 2 Notarized Affidavit of Owner/Represen documentary requirements undertaking for hospital, tatives 2 Receives and log application (affix infirmary and birthing Regulatory 3. Statistical Report for hospital name, signature, date and time Officers/ Officers (online ), birthing and Infirmary received) of the Week 4. Proof of compliance of 3 Reviews/Evaluates completeness Hospitals/Infirm deficiencies (if of documents and other ary/Birthing: monitored/inspected) requirements Leah Sungcad 5. MOA or Certificate of *If incomplete, returns to Clinical Affiliation applicant Lab/Blood 6. List of personnel *If complete, issues order of Station: 7.List of equipment/instrument payment Roldan.Cubillo 8.List of Ancillary Services for WTL: Mae Flores REFER hospital Within Dental Lab: Dr. TO 9. Copy of Valid PRC ID (five) 5 Edsel Roseus L. PAGE 10. Notarized Contract/Proof of days Villas / Officer of THRE Employment the Week E (3) 11. PSP certificate for clinical 4 Proceeds to cashier for payment Facility laboratory and submits photocopy of official Owner/Represen 12. Certificate of Participation in receipt tatives External Quality Assurance for 5 Prepares, initials, signs License to Regulatory clinical laboratory Operate (LTO) /Certificate of Officer 13. College/Board Certificates Accreditation (COA) Dr. Joei Ann 14.NVBSP Annual Blood Report Danes (SH) for Blood Station Dr. Guy Perez 15. Certificate of Inclusion for (OIC) Blood Station Dr. Sophia 16. Certificate of Compliance for M.Mancao(ARD) X-ray and Pharmacy (Hospital Dr. Jaime S. only) Bernadas (RD) 17. Copy of Official Receipt – 6 Releases License to Operate (LTO) Records Section payment / Certificate of Accreditation (Mr. Joel 18. Copy of Latest LTO/ATO/COA Saquilon/Ms. Edith Yu) REGULATORY OFFICERS: ROLDAN CUBILLO ENGR. ROSELIER GUIA DR. JAIME S. BERNADAS – REGIONAL DIRECTOR LEAH LIBERTY SUNGCAD MARY MONA THERESE SAAGUNDO DR. SOPHIA M. MANCAO- ASSISTANT REGIONAL DIRECTOR CLAUDETTE MAE FLORES CAROLYN BALANSAG DR. GUY R. PEREZ - OFFICER-IN-CHARGE CLARE MARGARET VERGARA GRACE PETALCORIN DR. JOSIE ANN B. DANES - SECTION HEAD JEEMAH VILLAVERDE JOSETTE NAVARRO “RENEWAL OF APPLICATION OF LICENSE TO OPERATE WILL STARTS EVERY MONTH OF OCTOBER UNTIL DECEMBER OF THE YEAR -

Pag Lisensyado…ProtektaD

H

SCHEDULE OF FEES Initial OSS: General Hospital Level 1 Ancillary Services General Clinical Laboratory Primary Secondary Tertiary Radiology c/o FDA 100MA 101-300MA 301-500MA 501-700MA Greater than 700MA Pharmacy c/o FDA Blood Collecting Unit Blood Station Water Analysis Primary Care Facilities Infirmary Birthing Non-Hospital Based Genera Clinical Laboratory Primary Secondary Tertiary Dental Prosthetic Laboratory Removable and Fixed Limited

3-3 Renewal

P6,500.00

P6,000.00

2,000.00 2,500.00 3,000.00

1,500.00 2,000.00 2,500.00

810.00 1,111.00 1,414.00 1,717.00 2,020.00 2,020.00 1,500.00 1,400.00 5,000.00

410.00 560.00 710.00 860.00 1,010.00 3,030.00 1,500.00 1,400.00 5,000.00

6,000.00 4,500.00

5,500.00 3,000.00

2,500.00 3,000.00 3,500.00

2,000.00 2,500.00 3,000.00

2,500.00 1,000.00

2,500.00 1,000.00

DEPARTMENT OF HEALTH REGIONAL OFFICE NO. VII

HEALTH FACILITIES LICENSING SECTION

CITIZEN’S CHARTER Working Days : Monday to Friday Working Hours: 8:00 A.M. to 5:00 P.M. VISION The transformational leader of health in Central Visayas.

Citizen’s Charter. Department of Health Regional Office No. 7. Date Published: June 2016

Address: Osmeña Boulevard, Cebu City, 6000 Philippines; Telephone No. 032-418-7630; Fax Number 032-254-0109; Official Website: www.ro7.doh.gov.ph /hfsrb.doh.gov Email Address [email protected]

MISSION Guarantee equitable, accessible, available Sustainable and more responsive quality Health care for all especially the marginalized Sector.

ANTI FIXER CAMPAIGN Rule VII Sec 3 of the Anti – Red Tape Act states that “ Fixers shall suffer the penalty of imprisonment not exceeding six years or a fine of not less than Twenty Thousand Pesos (Php 20,000.00) or both fine and imprisonment at the discretion of the court.

REPORT A FIXER Call or Text the following numbers DOH-RO7 Hotline – 032-412-4142 Civil Service Commission – 032-253-9050 Email Address: [email protected]