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Republic of the Philippines

Department of Health
REGIONAL OFFICE IV-A
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032; Telefax 440-3443
Email Add: chd4a_doh_calabarzon@yahoo.com

January 30, 2018

REGIONAL ORDER
No. ____________

SUBJECT: Guidelines for the Implementation of the


Memorandum of Agreement between Private Hospital
and/or Healthcare Facilities and this Office in relation
to Dengvaxia Vacinee

I. Rationale

The Department of Health through Regional Office IV-A would like to


address the present situation of the dengue vaccination; by strengthening
its ongoing surveillance of individuals vaccinated with Dengvaxia.

Thus, the immediate action of the Regional Office IV-A is the profiling of
those individuals vaccinated with dengvaxia, to streamline the process and
to focus in giving aid to qualified patient of the medical services needed.

Hence, this Order is a mechanism to ensure vaccinees to receive


medical assistance in connection to any adverse event following dengvaxia
immunization thru partnership with private health facilities.

“Ang paninigarilyo o paglanghap ng usok nito ay agad na nagdudulot ng paglapot ng dugo at pagkipot ng mga ugat, na
maaaring magdulot ng atake sa puso.” - U.S. Department of Health and Human Services, 2011
Republic of the Philippines
Department of Health
REGIONAL OFFICE IV-A
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032; Telefax 440-3443
Email Add: chd4a_doh_calabarzon@yahoo.com

II. SCOPE AND COVERAGE

These guidelines shall apply to those qualified patient who were


vaccinated with dengvaxia within the CALABARZON area, and to Private
Hospital and/or Healthcare Facilities who have been a party to the
Memorandum of Agreement to be executed.

III. DEFINITION OF TERMS

1.) Qualified Patients- Dengvaxia Vaccinees duly proven and


substantiated by supporting documents (immunization card, included in
the masterlist and certification from other health/school officials);

2.) Private Health Facility- duly licensed hospital or healthcare facility


wherein a qualified patient had been admitted/consulted whether or not
located within the territorial jurisdiction of this Office.

IV. GENERAL GUIDELINES

1.) The Department of Health through Regional Office IV-A will give medical
assistance to those qualified patients through private health facility;

2.) The PhilHealth case rate table will be the applicable rates corresponding to the
medical assistance to be covered and paid by this Office; any excess after
deduction from other funding resources (PCSO, DSWD, HMO, etc.) the Private
health facility should notify this Office together with the request letter “ANNEX A”
from the family of the qualified patient to extend and/or cover the remaining
balance;

“Ang paninigarilyo o paglanghap ng usok nito ay agad na nagdudulot ng paglapot ng dugo at pagkipot ng mga ugat, na
maaaring magdulot ng atake sa puso.” - U.S. Department of Health and Human Services, 2011
Republic of the Philippines
Department of Health
REGIONAL OFFICE IV-A
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032; Telefax 440-3443
Email Add: chd4a_doh_calabarzon@yahoo.com

3.) The patient must be vaccinated by Dengvaxia within the jurisdiction of this Office;

4.) Dengvaxia Vaccinee consulted/admitted to a private health facility whether or not


such patient is a member of PhilHealth.

V. IMPLEMENTATION MECHANISM

1. Qualified patient- are those individuals with history of dengvaxia vaccination.

2. Eligibility

2.1 Applies when duly proven and substantiated by supporting documents


such as but not limited to the immunization card, masterlist, certification from
other health/school officials; regardless of the number of doses given;

2.2 In cases of admission, subject to the availability of rooms, patients may be


accommodated at the dengvaxia vaccinees designated rooms;

2.3 Patients who are confined in the private room as certified by the hospital
subject to review by the authorized personnel of this Office, such as but not
limited to:
i. Emergency cases;
ii. Non-availability of dengvaxia vaccinees designated rooms
iii. Cases requiring intensive care
iv. Cases requiring isolation
v. Chronic and catastrophic cases requiring prolonged
admission

“Ang paninigarilyo o paglanghap ng usok nito ay agad na nagdudulot ng paglapot ng dugo at pagkipot ng mga ugat, na
maaaring magdulot ng atake sa puso.” - U.S. Department of Health and Human Services, 2011
Republic of the Philippines
Department of Health
REGIONAL OFFICE IV-A
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032; Telefax 440-3443
Email Add: chd4a_doh_calabarzon@yahoo.com

3. Service Coverage

a.) The following drugs, medicine, goods and other services prescribed by the
physician of the private health facility, provided it arose from and in
connection with the vaccination of dengvaxia, such as but not limited to:
i. Laboratory, imaging and all other diagnostic procedures,
ii. Drugs and medicines included in the Philippine National
Drug Formulary (exemptions to cleared by Pharmaceutical
Division)
iii. All clinically indicated medical and surgical procedures,
whether emergency or elective;
iv. Prescribed post-hospitalization, rehabilitation services,
aftercare program, appropriate mental and psychological
support, including those done on an outpatient basis;

4. Mechanism and Documentary requirements:

a. The following documentary requirements shall be submitted to the


authorized personnel of the Regional Office: certified true copy of the
Immunization Card, and the existing medical records
(laboratory/diagnostic procedure results, medical abstract), original
copy of itemized statement of account of the prospective qualified
beneficiary, regardless of the number of doses given

b. The amount of coverage to a qualified patient shall be eligible for


assistance in the amount specified in the Philhealth case rate table,
excess and after deducting the PhilHealth benefit package and other
more easily available charities or subsidies;

“Ang paninigarilyo o paglanghap ng usok nito ay agad na nagdudulot ng paglapot ng dugo at pagkipot ng mga ugat, na
maaaring magdulot ng atake sa puso.” - U.S. Department of Health and Human Services, 2011
Republic of the Philippines
Department of Health
REGIONAL OFFICE IV-A
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032; Telefax 440-3443
Email Add: chd4a_doh_calabarzon@yahoo.com

c. This Office may either deny or accept the request for the additional
coverage of medical assistance depending on the circumstance of
each case presented, to be reviewed and approved by the Regional
Director. Findings thereof is released as early as possible.

d. Reimbursement to a private health facility should be made one (1)


month from the submission of the complete requirements.

VI. ROLES AND RESPONSIBILITIES

A. Department of Health- Regional Office

a) The Regional Office shall designate an authorized personnel/s who shall be


responsible with the coordination of all related activities and concerned parties;

b) Facilitate logistical requirements of the private hospital as may be needed in the


pursuit hereof, such as the provision of NS1/RDT Diagnostic Test Kit;

c) Pay and settle approved medical assistance owing to the private health facility as a
result of the medical services rendered to a qualified patient.

d) Ensure safety and security of the staff/employees of both parties, any other persons
involved herewith;

e) Participate in the post-activity evaluation of activities related thereto, such as but not
limited to the submission of an Accomplishment Report.

“Ang paninigarilyo o paglanghap ng usok nito ay agad na nagdudulot ng paglapot ng dugo at pagkipot ng mga ugat, na
maaaring magdulot ng atake sa puso.” - U.S. Department of Health and Human Services, 2011
Republic of the Philippines
Department of Health
REGIONAL OFFICE IV-A
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032; Telefax 440-3443
Email Add: chd4a_doh_calabarzon@yahoo.com

B. Private Health Facility

a.) Establish a dengvaxia patient fast lane and prioritize provision of medical
services;
b.) The hospital shall designate a point person who shall be responsible for the
coordination of the qualified patient with the Department of Health Regional Office
IV-A point person
c.) Submit the billing statements and all relevant supporting documents to the Regional
Office for every qualified patient treated;
d.) Submit and furnish this Office the complete surveillance report “ANNEX B” with
the patient’s medical records to guarantee quality data sharing;
e.) Assist the authorized person of Region IV-A who will coordinate/monitor the
status of the qualified patient;
f.) Facilitate the request of the parents/guardians for the initial/additional medical
assistance;
g.) Participate in the post-activity evaluation of activities related thereto, such as the
accomplishment of fund utilization report.

VII. REPEALING CLAUSE

All other issuances and/or their provisions which are inconsistent with this
Order are hereby repealed.

“Ang paninigarilyo o paglanghap ng usok nito ay agad na nagdudulot ng paglapot ng dugo at pagkipot ng mga ugat, na
maaaring magdulot ng atake sa puso.” - U.S. Department of Health and Human Services, 2011
Republic of the Philippines
Department of Health
REGIONAL OFFICE IV-A
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032; Telefax 440-3443
Email Add: chd4a_doh_calabarzon@yahoo.com

VIII. EFFECTIVITY CLAUSE

This administrative order shall take effect immediately.

RIO L. MAGPANTAY, MD, PHSAE, CESO III


Regional Director

“Ang paninigarilyo o paglanghap ng usok nito ay agad na nagdudulot ng paglapot ng dugo at pagkipot ng mga ugat, na
maaaring magdulot ng atake sa puso.” - U.S. Department of Health and Human Services, 2011

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