Republic of the Philippines

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

Non-compliance to the following requirements will not result to non-issuance of LTO (Birthing Home) but compliance at a
later date still required:

I. TECHNICAL REQUIREMENTS

A. Personnel

1. Physician

a. A valid certificate of Good Standing from the Accredited Professional Organization (APO) of
Physicians of PRC and/or any DOH recognized association of Physicians (For Family Medicine
Physicians, Municipal Health Officers and General Practitioners)

2. Nurse

a. A valid certificate of Good Standing from the Accredited Professional Organization (APO) of
Nurses of PRC and/or any DOH recognized association of Nurses

3. Midwife

a. A valid certificate of Good Standing from the Accredited Professional Organization (APO) of
Midwives of PRC and/or any DOH recognized association of Midwives

4. Administrator

a. Notarized Contract of Employment

5. Clerk

a. Notarized Contract of Employment

B. Equipment, Instrument/Supplies, Basic Medicines

Equipment/Instruments Minimum Requirements

1. General Administrative Service

a. Bench 1

b. Cabinet 1

c. Calculator 1

d. Chair 1/staff

e. Desk 1/staff

d. Electric Fan 1

Pag Lisensyado... ProtektaD H

Building 15, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila HFSRB letterhead
Trunk Line 651-7800 locs. 2500-06;2508-12; 2525-26; 2528; telefax 711-6982/7119572;DL741-2707 Revision:03
04/08/2016
URL: www.hfsrb.doh.gov.ph.; e-mail: hfsrb@co.doh.gov.ph.
 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
e. Open shelf 1

f. Typewriter /computer 1

2. Clinical Services

Treatment Room (same as Outpatient Area)

1. Foot stool 1

2. Gooseneck/examining light 1

Ward (includes Labor Room and Recovery Room)

1 . Lubricant 1

2. Wall clock with second hand 1

3. Bed sheets Depends on the number of beds

Birthing Room
1. Emergency light/flashlight 1

2. Foot stool 1

3. Instrument table 1

4. Instrument cabinet 1

5. IV stand 1

6. Kelly pad 1 (optional)

7. Pail 1

8. Stool 1

9. Suction apparatus (not for routine suctioning, may be 1

used for newborns whose airway may be blocked)

10. Pair(s) of slippers (exclusive for birthing room use) 2 pairs

11. Room thermometer (non-mercurial), maintain room 1

temp. between 25-28 degress Celsius

12. Gowns or patients’ gown For Birthing Room use

13. Linen for drying newborns 1 per bed

14. Sterile drapes 1 per bed

15. Scrub suits 1 per staff

Pag Lisensyado... ProtektaD H

Building 15, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila HFSRB letterhead
Trunk Line 651-7800 locs. 2500-06;2508-12; 2525-26; 2528; telefax 711-6982/7119572;DL741-2707 Revision:03
04/08/2016
URL: www.hfsrb.doh.gov.ph.; e-mail: hfsrb@co.doh.gov.ph.
 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
Basic Medicines
1. Bethamethasone (Diprospan) 7mg per ampule (preferred) 1
or Dexamethasone (Scancortin) 5mg/ml per ampule
(alternative)

2. Calcium Gluconate 10mg/ampule 1

3. Diphenhydramine 50mg/ampule 1

4. Magnesium sulphate ampule 1

5. Tetanus toxoid containing vaccines 2

6. Tranexamic acid ampule 1

Basic Supplies
1. 70% Isopropyl alcohol 1 bottle

2. Disposable syringes (1cc, 3cc,5cc,10cc) with needles 1 each

3. IV tubings (macro and micro-drip sets 1 each

4.Nasal cannulas or plastic face masks 1

5.Plaster 1

6.Povidone-iodine solution 1 bottle

7.Sterile cotton balls 1 pack

8.Sterile cotton pledgets 1 pack

9.Sterile gauzes 1 pack

10. Surgical caps 1 box

11.Surgical masks 1 box

12. Sharps container 1

13. Suction catheters (adult and newborn sizes) 1 per bed

Pag Lisensyado... ProtektaD H

Building 15, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila HFSRB letterhead
Trunk Line 651-7800 locs. 2500-06;2508-12; 2525-26; 2528; telefax 711-6982/7119572;DL741-2707 Revision:03
04/08/2016
URL: www.hfsrb.doh.gov.ph.; e-mail: hfsrb@co.doh.gov.ph.
 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
C. Physical Facility

1. Posted in conspicuous area

a. License to Operate (for renewal)
b. Local Permits
c. Vision and Mission
d. Organizational Chart

2. Signages
a. Information
b. Prohibition and Warning
c. Process Flow of Clinical Services

II. FACILITY OPERATIONS

A. Manual of Operations/Standards Operating Procedures

Standards and Requirements

1. Vision and Mission

2. Organizational Chart

3. Preventive maintenance program for equipment

a. Plan for essential equipment replacement in case of breakdown
b. Record of equipment
c. Operational manuals of all equipment and instruments

4. Documented policies and procedures for handling complaints, reporting and analysis of incidents,
adverse events, etc.

5. Pest and vermin control program

a. Documented policies for pest and vermin control program

B. Records/Files

Standards and Requirements

1. Copies of Annual Birthing Home Statistical Report received by the regional office
2. Notarized Memorandum of Agreements for outsourced services
a. Waste Management service (if outsourced)
b. Pest and vermin control service (if outsourced)

Pag Lisensyado... ProtektaD H

Building 15, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila HFSRB letterhead
Trunk Line 651-7800 locs. 2500-06;2508-12; 2525-26; 2528; telefax 711-6982/7119572;DL741-2707 Revision:03
04/08/2016
URL: www.hfsrb.doh.gov.ph.; e-mail: hfsrb@co.doh.gov.ph.