MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THESE PRESENTS;

MEMORANDUM OF AGREEMENT is entered into, this January 3, 2018 in the

Bagong Silang I Labo, Camarines Norte Philippines by and between:

ERLINDA E. VITAL, of legal age, married, Filipino and resident of Bagong Silang I
Labo, Camarines Norte and owner of Vital Lying- In Clinic hereinafter referred to
as the MIDWIFE PROVIDER.

~and~

ALICIA C. PAJO, M.D. F.P.O.G.S of legal age married/single, Filipino, a resident of

Daet Camarines Norte and affiliated with LOURDES HOSPITAL hereinafter referred
to as PARTNER PHYSICIAN.

WHEREAS, the MIDWIFE PROVIDER is required to have (2) PARTNERS PHYSICIANS

for referral and further management of both mother and the new born, needing
higher levels of maternal care, respectively;

WHEREAS, THE PARTNER PHYSICIAN shall be Philippine Health Insurance

Corporation (PhilHealth) accredited and should be affiliated with a PhilHealth
accredited secondary or tertiary hospital;

WHEREAS, both parties have agreed that the PARTNER PHYSICIAN shall accept
patients referred by the MIDWIFE PROVIDER and provide appropriate needed
care to these patients;
 TERMS AND CONDITIONS

ARTICLE I

DEFINITION OF TERMS

1. The maternity care Package is a PhilHealth Outpatient Benefit Package

that Covers payment of prenatal care of first and second low – risk
pregnancies, normal birth, routine new born care, postpartum care, and
family planning rendered by PhilHealth accredited Outpatient Clinic.

2. Low – risk pregnancy is a pregnancy with no identified risk factor.

Normal birth is identified as spontaneous in onset, low – risk at the start
of labor, and remaining so throughout the labor and delivery. The infant
is born spontaneous in the vertex position between 37 and 40
completed weeks of pregnancy. After birth, Mother and infant are in
good condition.

3. The OUTPATIENT CLINIC for the maternity Package is a non-hospital

outpatient.

Facility with adequate facilities and competently trained staff capable of

providing all the maternal and neonatal services.

4. REFERAL is the process by which the MIDWIFE PROVIDER directs the

patients to PARTNER PHYSICIAN due to onset of risk, for further
management of patient’s care.
 ARTICLE II
OBLIGATION OF THE MIDWIFE PROVIDER

1.The MIDWIFE PROVIDER shall render prenatal, birth delivery, routine new born care, and
postpartum service to female beneficiaries during their first and second low – risk pregnancies
and normal deliveries.

2.The MIDWIFE PROVIDER shall be able to attend to all eligible patients at all times, especially
during intrapartum.

3.The MIDWIFE PROVIDER shall abide by/comply with the prescribe clinical pathways and
practice guidelines for the maternity care package.

4.The MIDWIFE PROVIDER shall do a pregnancy risk assessment during the first prenatal visit of
the patient. Any patients who present any of the following EXCLUTION CIRTERIA shall be
referred to the PARTNER PHYSICIAN for obstetric complications the soonest possible time.

1.1. History of previous major obstetric / gynaecologic operative interventions ( e.g

Caesarean
Section, salpingectomy for ectopic pregnancy, Oophorectomy).

1.2 History of three (3) or more miscarriages, or one (1) stillbirth.

1.3 Maternal age under 19 years old.

1.4 Elderly primis with maternal age of 35 years old and older.

1.5 Multiple pregnancy (e.g. twins, triplets, etc. )

1.6 Abnormal fetal presentation (e.g. breech ).

1.7 Placental abnormalities (e.g. low – lying placenta, placenta previa ).

1.8 Uterine abnormalities (e.g. mayoma uteri).

1.9 Ovarian abnormalities (e.g. ovarian cyst ).

1.10 history of medical conditions (e.g. hypertension, heart disease, diabetes, thyroid disorder,
obesity, moderate-severe asthma, pre-eclampsia, eclampsia, epilepsy, renal disease, bleeding
disorder).

1.11 Other risk factor that may arise during present pregnancy (e.g. premature contractions,
vaginal bleeding, ) that the midwife perceives to warrant a referral to an obstetrician/physician
for further management.

5. Should the patient develop the risk factors during the course of the present
pregnancy, or should the patient require intrapartum referral for obstetric emergencies (e.g.
preterm labor, prolonged labor, fetal distrees, abruption placenta, the MIDWIFE PROVIDER
shall refer the patients immediately to the PARTNER PHYSICIAN in obstetric for the further
management and/or delivery.

6. The MIDWIFE PROVIDER is autonomous, and has direct responsibility and liability for
his/her judgment and action.
 MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THESE PRESENT:

MEMORANDUM OF AGREEMENT is entered into, this January 3,2018 in the Bagong

Silang I Labo, Camarines Norte Philippines by and between:

ERLINDA E. VITAL, Legal age Married Filipino a resident of Bagong Silang I Labo
Camarines Norte and hereafter referred as midwife provider.

~and~

MARIA HIRALDIN O. LAZO, MD,DPPS, of legal age, married, Filipino, and with postal and office
address at Bagasbas Road, Daet Camarines Norte, hereinafter referred to as partner physician.

WITHNESS:

WHEREAS, the PARTY OF THE FIRST PART is the owner and registered midwife of the
maternity and Lying –in clinic, the PARTY OF THE SECOND PART IS A Pediatric Doctor;

WHEREAS, the partner physician shall accept all patient properly referred by the
midwife provider.

The herein PARTIES agree that their attendance to the patients shall be independent for
each other. Hence, each PARTY shall be individually responsible for any incident that may occur
during the time that the patient is under his/her care. The determination of the liabilities of
both PARTIES in the care of the patient shall depend upon the specific factual circumstances of
the case.

WHEREAS, the term of this agreement shall be for a period of ONE YEAR Erlinda E. Vital
commencing form January 1, 2016 and expiring on January 1, 2017.

IN WITHNESS WHEREOF, the parties hereof have set their hand this ______________
Day of _______,________ at Labo, Camarines Norte.

ERLINDA E. VITAL MARIA HERALDIN O. LAZO, MD, DPPS

Party of the first Part Party of the second Part

SIGNED IN THE PRESENCE OF:

NIEVES E. ABIAR CATHERINE M. VILLANUEVA

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAMARINES NORTE ) S.S.
MUNICIPALITY OF DAET )
BEFORE ME, this _______ day of ________________,________in the municipality of Daet,
Camarines Norte, note, personally appeared the following persons:

Identification Card No. / CTC.No. Date and place of issue

ERLINDA E. VITAL PRC LICENCE NO. 0019141 June 5, 2017/PRC
MANILA
DRA. MARIA HERALDIN O. LAZO PRC LICENCE NO. 106120 SEPT.19, 2005 PRC
MANILA

Known to be the same person who executed the foregoing instrument, and they
acknowledgement to me that the same is their free and voluntary act and deed.

WITHNESS MY HAND AND SEAL

Doc. No.
Page No.
Book No.
Series No.
 ARTICLE
COMMON VERSIONS

The herein PARTIES agree that their attendance to the patients shall be independent for each
other. Hence, each PARTY shall be individually responsible for any incident that may occur
during the time that the patient is under his/her care. The determination of the liabilities of
both PARTIES in the care of the patients shall depend upon the specific factual circumstance of
the case.
IN WITHNESS WHEREOF, the PARTIES have set their hands to this MEMORANDUM OF
AGREEMENT at the date and place written above.

ERLINDA E. VITAL DRA. ALICIA C. PAJO

MIDWIFE PROVIDER PARTNER PHYSICIAN

NIEVES E. ABIAR CATHERINE M. VILLANUEVA

SIGNED IN THE PRESENCE:

-------------------------------------------------------------------------------------------------------------
ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAMARINES NORTE) S.S.
MUNICIPALITY OF DAET)
BEFORE ME, this __________ day of ____________________,___________,in the municipality
of Labo, Camarines Norte, note, personally appeared the following person:

Known to be the same person who executed the foregoing instrument, and they acknowledge
to me that the same is their free and voluntarily act and deed.

WITHNESS MY HAND AND SEAL

Doc. No
Page. No.
Book No.
Series of
 VITAL LYING –IN CLINIC
PUROK 1 BAGONG SILANG 1
LABO, CAMARINES NORTE

CERTIFICATION OF FUNCTIONAL PHILHEALTH PORTAL

I, ERLINDA E. VITAL, Medical director / Chief of Hospital of

VITAL LYING –IN CLINIC
(name of hospital/ facility)
with postal address at Purok 1 Bagong Silang 1, Labo, Camarines Norte
Purok 1 Bagong Silang 1 Labo, Camarines Norte do certify under oath that:
(Hospital / Facilty Address)

1. The portal of VITAL LYING-IN CLINIC is functional and has been in use
since installation.

2. That the following are the only authorized users of our PhilHealth Portal
1. ERLINDA E. VITAL
2.
3.
4.
5.

3. That we are attaching a sample of a recently processed PhilHealth Benefit

Eligibility Form (PBEF) as proof of its functionality.

4. Thaw we assure Philhealth that we shall continually use the portal and
shall notify PhilHealth if at any time said portal become inaccessible.

In witness whereof, I hereby affix my signature this 31st day of January at Bagong
Silang 1 Labo, Camarines Norte.

ERLINDA E. VITAL
Signature over Printed Name

Subscribed and sworn to this ____ day of _____________________ at

________________________