MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

This Memorandum of Agreement is entered into by and between:

TALAVERA GENERAL HOSPITAL located at MAESTRANG KIKAY DISTRICT,

TALAVERA, NUEVA ECIJA, herein represented in this act by its Chief of Hospital II,
MA. ISABEL S. GALLARDO, MD, MHA, FICS, FPCHA herein referred to as the
“SERVICE PROVIDER”.

-and-

RURAL HEALTH UNIT – MUNICIPALITY OF TALAVERA, located at SAN

RICARDO, TALAVERA, NUEVA ECIJA, herein represented by its Municipal Health
Officer, ________________________________, herein after referred to as the
“REFERRAL FACILITY”.

WITNESSETH That: -

WHEREAS, to ensure that quality healthcare is provided to the patients, the

Department of Health requires the SERVICE PROVIDER to establish a partnership and
referral system with other health service providers/facilities;

WHEREAS, the REFERRAL FACILITY should be an accredited TB DOTS

Provider;

WHEREAS, both parties have agreed that REFERRAL FACILITY shall accept
patients referred by the SERVICE PROVIDER and provide TB DOTS Services to these
patients;

WHEREAS, the REFERRAL FACILITY agrees to provide the Services to the

patients of the SERVICE PROVIDER based on terms and condition of this
AGREEMENT;

NOW, THEREFORE, for and in consideration of the foregoing premises, the

parties herein agree to the following terms and conditions:

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 TERMS AND CONDITIONS

ARTICLE I

DEFINITION OF TERMS

1. REFERRAL – is the process by which the SERVICE PROVIDER, having limited

resources to handle TB DOTS Services, seeks the assistance of an accredited TB
DOTS Service Provider to assist in, or take over the diagnosis of the TB patient.

2. The facility that starts the referral process is called the SERVICE PROVIDER,
and the facility that accepts the referred case is called the REFERRAL
FACILITY.

3. The referral process is documented using the Form 2a. NTP Laboratory Request
and Result Form provided by the SERVICE PROVIDER, that is kept and filed by
the Service Provider.

4. Accredited TB DOTS Facility - DOTS facility – A health care facility, whether

public or private, that provides TB-DOTS services in accordance with the policies
and guidelines of the National TB Control Program (NTP), DOH

ARTICLE II

OBLIGATIONS OF THE SERVICE PROVIDER

1. The SERVICE PROVIDER shall assess the patient, gather relevant information
and provide necessary care possible;

2. The SERVICE PROVIDER shall make the decision to refer the patient only after
the collection and analyzation of relevant information using the protocol of care as
guide;
3. The SERVICE PROVIDER, upon assessment of the patient as presumptive
DSTB/DRTB, shall collect sputum sample;

4. The SERVICE PROVIDER shall communicate with the REFERRAL

FACILITY to make an appointment or other arrangements for the referral;

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5. The SERVICE PROVIDER shall properly fill up the Form 2a. NTP Laboratory
Request and Result Form with complete information;

ARTICLE III

OBLIGATIONS OF THE REFERRAL FACILITY

1. The REFERRAL FACILITY shall assign a designated point person for this
agreement;
2. The REFERRAL FACILITY shall accept patients properly referred by the
SERVICE PROVIDER;

3. The REFERRAL FACILITY’s point person shall pick-up sputum samples on

scheduled days of the week, Monday, Wednesday, and Friday, at the SERVICE
PROVIDER’s laboratory;

4. The REFERRAL FACILITY’s point person shall log the date of receipt and
number of samples at the SERVICE PROVIDER’s laboratory;

5. The REFERRAL FACILITY shall provide the results within 3 days after pick-up
of the sputum samples using the Form 2a. NTP Laboratory Request and Result
Form;

6. The REFERRAL FACILITY’s point person shall hand over the results to the
SERVICE PROVIDER’s TB DOTS point persons only.

ARTICLE IV

KEY TERMS

1. Period of Delivery of Services – The REFERRAL FACILITY shall commence

the provision of the Services on July 15, 2019, and shall continue until the Service
Provider has an operational TB DOTS Clinic, or unless terminated by either
party.
2. Place and Delivery of Services – The REFERRAL FACILITY shall provide the
Services at RHU – Talavera.

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 ARTICLE V

GENERAL TERMS

3.1. Warranty – The REFERRAL FACILITY represents and warrants that:

a. it will perform the Services with reasonable care and skill

3.2. Limitation of Liability

a. Either party’s liability in contract, tort or otherwise (including negligence) arising
directly out of or in connection with this Agreement and every applicable part of it shall
be limited in aggregate to the price of the Services.

4.3. Termination – Either Party may terminate this Agreement upon notice in writing
within 30 days, after discovery or knowledge that:

a. The other is in breach of any material obligation contained in this Agreement, which
is not remedied (if the same is capable of being remedied), within 30 days of written
notice from the other Party so to do: or
b. A voluntary agreement is approved, a bankruptcy or an administration order is made
or a receiver is appointed over any of the Party’s assets or an undertaking or a resolution
or petition to wind up the other party is passed or presented ( other than for the purposes
of amalgamation or construction) or any analogous procedure in the country of
incorporation of either party or if any circumstances arise which entitle a court of
competent jurisdiction or a creditor to appoint a receiver, administrative receiver of
administrator or to present a winding-up or make a winding up order in respect of the
other Party.

Any termination of this Agreement (whosoever occasioned) shall not affect any secured
rights or liabilities of either Party nor shall effect the coming into force or the
continuance on force of any provision hereof which is expressly or by implication
intended to come into or continue in force on or after such termination.

3.4. Relationship of the Parties - the Parties acknowledge and agree that the Services
performed by the Referral Hospital, its employees, agents or subcontractor shall be as
an independent contractor and that nothing in this Agreement shall be deemed to

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constitute a partnership, joint venture, agency relationship or otherwise between the
parties.

3.5. Confidentiality – Neither Party will use, copy, adapt, alter, or part with possession
of any information of the other which is disclosed otherwise comes into its possession
under or in relation to this Agreement, and which is of confidential in nature. This
obligation will not apply to information which the recipient can prove was in its
possession at the date it was received of obtained or which the recipient obtains from
other person with good legal title to it or which is in or comes from the public domain
otherwise than through the default or negligence of the recipient or which is
independently developed by or for the recipient.

3.6 Notices – Any notice which may be given by a Party under this Agreement shall be
deemed to have been duly delivered by hand, registered mail, facsimile transmissions
or electronic mail to the address of the other Party as specified in this Agreement or any
other address notified in writing to the other Party.

3.7. Miscellaneous –
a. The failure of wither party to enforce its rights under this Agreement at any time for
any period shall not be construed as a waiver of such rights.
b. If any part, term or provision of this Agreement is held to be legal or unenforceable,
neither the validity nor enforceability of the remainder of its Agreement shall be
affected.
c. Neither party shall assign or transfer all or any parts of its rights under this Agreement
without the consent of the other party.
d. This Agreement may not be amended for any other reason without the prior written
agreement of both parties.
e. This Agreement constitutes the entire understanding between the parties relating to
the subject matter hereof unless any representation or warranty made about this
Agreement was made fraudulently and save as may be expressly referred herein,
supersedes all prior representations, writings, negotiations or understandings with
respect hereto.
f. Neither party shall be liable for failure to perform or delay in performing any
obligation under this Agreement if the failure of the delay is caused by any
circumstances beyond its reasonable control, including but not limited to acts of God,

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 war, civil commotion or industrial dispute. If such delay or failure, either party shall be
entitled to terminate this Agreement by notice in writing to the other.
g. This Agreement shall be governed by existing Philippine laws, rules and regulations
and the Parties agree to submit disputes arising out of or in control with this Agreement
to arbitration before invoking the jurisdiction of the court.

IN WITNESS WHEREOF, we have hereunto set our hands this _____ day of
____________________, 2019 at __________________, Nueva Ecija.

TALAVERA GENERAL RURAL HEALTH UNIT –

HOSPITAL MUNICIPALITY OF TALAVERA
By: By:

MA. ISABEL S. GALLARDO, ________________________

MD, MHA, FICS, FPCHA _________________________
Chief of Hospital II Municipal Mayor
PRC I.D No.: 0073074 I.D No.: ___________

SIGNED IN THE PRESENCE OF:

FRANCIS R. CARESUSA __________________________

TB DOTS Chairperson Municipal Health Officer
PRC I.D No.: __________ PRC I.D No.: _______________

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