Transfer

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MEMORANDUM OF AGREEMENT FOR PATIENT TRANSFER
This TRANSFER AGREEMENT (“Agreement”) is made as of this

day of in the , Cavite by and between:
DINDO N. CASTRO MATERNITY CLINIC, a health facility duly accredited and
existing under and by virtue of the laws of the Philippines, with office address at
BUENAVISTA 3 GENERAL TRIAS, CAVITE, represented by this act its owner
DINDO N. CASTRO MD, hereafter as the “CLINIC”.
GENTRI MEDICAL CENTER AND HOSPITAL a domestic corporation duly

organized and existing under and by virtue of the laws of the Philippines, with
office address at Barangay Manggahan, Santusan St., General Trias, Cavite,
represented by this act its Hospital Administrator, DR. JERRIMO GENUINO MD,
PRESIDENT / CEO hereafter referred to as the “ HOSPITAL”.
WITNESSTH: THAT—
WHEREAS, the parties hereto desire to enter into this AGREEMENT governing
the transfer of patients between two facilities both located in GENERAL TRIAS, CAVITE
and
WHEREAS, the parties hereto desire to enter into this AGREEMENT in order to
specify rights and duties of each parties and to specify the procedure ensuring the
timely transfer of patients between the facilities;
NOW, THEREFORE, to facilitate the continuity of care and the timely transfer of
patient and records between the facilities, the parties hereto agree as follows:
TRANSFER OF PATIENT
In the event a patient (pregnant mother/ mother and newborn baby) of the
CLINIC is requiring the services of the HOSPITAL, the CLINIC or its patient’s Attending
Physician will contact the dispatch center of the HOSPITAL to arrange for appropriate
treatment as contemplated herein. Neither the decision to transfer a patient nor the
decision to not accept a request to transfer will be based upon the patient’s inability to
pay the services rendered by either the facility, or a patient’s choice for other hospitals.
The HOSPITAL will provide ambulance services to the CLINIC anytime needed. The
HOSPITAL’s responsibility for the patient care shall begin when the patient is admitted
to the HOSPITAL.
RESPONSIBILITIES OF THE CLINIC
The CLINIC shall be responsible for performing and ensuring performance of the
following:
a. Refer to the hospital all patients who are considered as “HIGH RISK”.
These are the patients belonging to the following categories:
 Maternal age under 19 years old
 Elderly primigravida with maternal age of 35 years and over.
 Multiple pregnancies (twin, triplets)
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 Ovarian abnormalities (e.g. ovarian cyst)

 Uterine abnormalities (e.g. myoma uteri)
 Placental abnormalities (e.g. placenta previa)
 Abnormal fetal presentation (e.g. breech presentation)
 History of at most three (3) miscarriages or 1 stillbirth
 History of previous major obstetrics / gynecologic operative
intervention (e.g. Caesarian section, uterine myomectomy,
salphingectomy, oophorectomy)
 History of medical condition (e.g. hypertension, heart disease, pre-
eclampsia, eclampsia, diabetes, thyroid disorder, obesity, moderate to
severe asthma, epilepsy, renal disease, bleeding disorder)
 Other risk factor that may arise during the present pregnancy (e.g.
premature contraction, vaginal bleeding) that warrants a referral for
further management.
b. Provide within its capabilities, for the medical screening and stabilizing
treatment of the patient prior to transport.
c. Arrange of the safe transport and care of the patient during transfer.
d. Prior to transfer, the transferring physician or any of the CLINIC’s
representative shall contact and secure a receiving physician and / or at the
HOSPITAL who shall attend to the medical needs of the patient and who will
accept responsibility for the patient’s medical treatment and hospital care.
e. Provide with its capabilities, appropriate personnel, equipment and services to
assist the transferring physician or midwife with the coordination and transfer
of the patient.
f. Provide with its capabilities, personnel, equipment, and life support measures
determined appropriate for the transfer of the patient by the transferring
physician or midwife.
g. Forward to the receiving physician and the HOSPITAL a copy of those
portion of the patient’s medical records that are available and relevant to the
transfer and continued care of the patient, including records related to the
patient’s condition, preliminary diagnosis, treatment provided, results of any
test and with respects to the patient with an emergency medical condition
that has not been stabilized, a copy of the patient’s informed consent to the
transfer or physician’s certification that the medical benefits outweigh the risk
of transfer. If all the necessary and relevant medical records are not available,
then the records will be forwarded by the CLINIC as soon as possible.
h. Notify the HOSPITAL of the estimated time of arrival of the patient.
RESPONSIBILITIES OF THE HOSPITAL

The HOSPITAL shall be responsible for performing or ensuring the performance
of the following:
a. Provide, as promptly as possible, confirmation to the CLINIC regarding the
availability of bed(s), appropriate facilities, services and the staff necessary to
treat the patient.
b. Provide, within its capabilities, personnel, equipment and services to assist
the receiving physician with receipt and treatment of the patient at the
HOSPITAL and provide, on request, the names of on-call physicians to the
CLINIC.
c. Provide ambulance service for transfer of patient from the CLINIC to the
HOSPITAL the soonest possible time.
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d. Provide the CLINIC with a copy of the medical records of the patient that were
generated at the HOSPITAL, if the patient is returned to CLINIC by the
HOSPITAL.
e. Maintain the confidentiality of the patient’s medical records in accordance with
applicable laws
f. Provide medical information to the referring on a regular and periodic basis.
RETRANSFER; DISCHARGE
At such time as the patient is ready to transfer back to the CLINIC or another
healthcare facility or discharge from the HOSPITAL, in accordance with the direction
from the HOSPITAL and with proper notification of the patient’s family or guardian, the
patient will be transferred to the agreed upon location. If the patient is to be transferred
back to the CLINIC, the HOSPITAL will be responsible for the care of the patient until
the time the patient is re-admitted to the CLINIC
COMPLIANCE WITH THE LAW

Both the facilities shall comply with the applicable laws, rule and regulations
including without limitation, those laws and regulations governing the maintenance of
medical records and confidentiality of patient information as well as with all standards
promulgated by a relevant accrediting agency.
RESPONSIBILITY
The facility shall each be responsible for their own acts and omissions in the
performance of their duties, hereunder, and the acts and omissions of their own
employees and agents.
TERM; TERMINATION
1. The initial term of this AGREEMENT (“Initial Term”) shall be for a period of
one year unless sooner terminated as provided herein. At the end of the initial
Term and each Renewal Term (as hereinafter defined), if any, this
AGREEMENT may be renewed for the additional term of one (1) year
(“Renewal Term”), but only upon mutual agreement of both parties.
2. Either party may terminate this AGREEMENT without any cause upon thirty
(30) days written notice to the party. Either party may terminate this
AGREEMENT upon breach by the other party of any material provision of this
AGREEMENT, provide such breach continues for five (5) days after the
receipt by the breaching party of the written notice of such breach from the
non-breaching party. This AGREEMENT may be terminated immediately
upon the occurrence of either facility closes or discontinues operations to
such an extent that the patient care cannot be carried out adequately.
3. This AGREEMENT may be renewed for subsequent one (1) year term upon
the mutual consent of the parties.
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ARBITRATION
Any dispute or controversy arising under, out of or in connection with, or in
relation to this Agreement, or any amendment hereof, or the breech hereof shall be
determined and settled in the City of Dasmarinas Cavite. The cost shall be borne
equally by both parties. During the pendency of such any arbitration and until final
judgement thereon has been entered, this AGREEMENT shall remain in full force and
effect unless otherwise terminated provided hereunder.
ENTIRE AGREEMENT: MODIFICATION

This AGREEMENT contains the entire understanding of both parties with respect
to the subject matter hereof and supersedes all prior agreements, oral or written and all
other communication between parties relating to such matter. This AGREEMENT may
not be amended or modified except by mutual written agreement.
GOVERNING LAW
This AGREEMENT shall be constructed in accordance with the laws of the
Philippines.
ASSIGNMENT; BINDING EFFECT

Facilities shall not assign or transfer, in whole or part, this AGREEMENT or any
facilities’ rights, duties or obligations under this AGREEMENT without prior written
consent from the other facility and any assignment or transfer by either facility without
such consent shall be null and void. This AGREEMENT shall insure the benefit binding
upon the parties hereto and their respective heirs, representatives, successors and
permitted assign.
IN WITNESS WHEREOF, the parties have hereto set their hands on the date and the
time at the place first mentioned.
Dindo N. Castro MD Dr Jerrimo Genuino MD

Owner President / CEO
Dindo N. Castro Maternity Clinic Gentri Medical Center and Hospital
WITNESSES:

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MEMORANDUM OF AGREEMENT FOR PATIENT TRANSFER

This TRANSFER AGREEMENT (“Agreement”) is made as of this

GENTRI MEDICAL CENTER AND HOSPITAL a domestic corporation duly

 Ovarian abnormalities (e.g. ovarian cyst)

RESPONSIBILITIES OF THE HOSPITAL

COMPLIANCE WITH THE LAW

ENTIRE AGREEMENT: MODIFICATION

ASSIGNMENT; BINDING EFFECT

Dindo N. Castro MD Dr Jerrimo Genuino MD

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