MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

STA RITA RURAL HEALTH UNIT, A health unit that provides comprehensive and primary
health care services to the townspeople of Sta. Rita Pampanga. The Health Care team provides proper
consultations, laboratory tests, and treatments that people need and deserve, hereinafter referred to as the
Municipal Mayor of Sta. Rita

“PRIMARY CARE FACILITY”.

-and-

DIOSDADO P. MACAPAGAL MEMORIAL HOSPITAL, a medical and corporate entity

Fleur-de-lis M. Zapanta, MDElizabeth V. Pasinag, RN Hon. Arthur L. Salalila

duly registered in accordance with the laws of the Republic of the Philippines with business at Jose Abad
Santos Ave, Guagua, Pampanga represented by its Chief of Hospital, Fleur-de-lis M. Zapanta, MD,
hereinafter referred to as the “REFERRAL HOSPITAL”.

-WITNESSETH-
Public Health Nurse

WHEREAS, Sta Rita Rural Health Unit is engaged in the service of providing dental
consultation, tooth extraction, and dental care;

WHEREAS, Diosdado P. Macapagal Memorial Hospital has a qualified Dental Specialist having
full expertise to operate dental care clinic and provide surgeries;

WHEREAS, there are onset risk cases which the REFERRAL HOSPITAL can handle better
Municipal Health Officer Chief of Hospital Diosdado P. Macapagal Memorial Hospital

with the help of an oral surgeon after examination of patients and determination that they will require
further adept medical supervision;

WHEREAS, all risk cases handled by herein PRIMARY CARE FACILITY shall be exclusively
referred to the REFERRAL HOSPITAL;

NOW THEREFORE, for and in consideration of the foregoing premises, the hereinafter parties
have agreed to the following terms and conditions.
Jovel P. Gangcuangco, MD
 TERMS AND CONDITIONS

Article I
DEFINITIONS OF TERMS

1. The PRIMARY CARE FACILITY known as STA RITA RURAL HEALTH UNIT is a non-
hospital facility with competently qualified staff capable of providing dental services.
Municipal Mayor of Sta. Rita

2. The REFERRAL HOSPITAL is a Philhealth-Accredited secondary or tertiary hospital

equipped with state-of-the-art medical instruments and equipment needed for further
management of the patient’s care.
Fleur-de-lis M. Zapanta, MDElizabeth V. Pasinag, RN Hon. Arthur L. Salalila

3. REFERRAL is the process by which the PRIMARY CARE FACILITY directs the patient to
the REFERRAL HOSPITAL due to oral surgeries and risk cases, for further management of
the patient’s care.
Public Health Nurse

Article II
OBLIGATIONS OF THE PRIMARY CARE FACILITY
1. The PRIMARY CARE FACILITY shall render dental consultation, tooth extraction, and
dental care to all preschoolers, targeted school children, pregnant and lactating women, other
Municipal Health Officer Chief of Hospital Diosdado P. Macapagal Memorial Hospital

adults, and senior citizens to prevent and treat dental problems.

2. The PRIMARY CARE FACILITY shall provide an ambulance/vehicle to transport patients

to the referral hospital should an emergency arise related to complaints on oral cases.

Article III
OBLIGATIONS OF THE REFERRAL HOSPITAL
1. The REFERRAL HOSPITAL shall accept ALL patients properly referred by the PRIMARY
CARE FACILITY.

2. The REFERRAL HOSPITAL shall be available to attend to all patients at all times.

3. The REFERRAL HOSPITAL shall accept referrals on a 24-hour basis for oral emergency
Jovel P. Gangcuangco, MD

cases.
 Article IV
COMMON PROVISIONS
The herein PARTIES agree that their attendance to the patients shall be independent of each
other, hence, each PARTY shall be individually responsible for any incident that may occur during the
time the patient is under his/her care. The determination of the liabilities of PARTIES in the care of the
patients shall depend upon the specific factual circumstances all around the patients.

IN WITNESS WHEREOF, the parties have hereunto signed this MEMORANDUM OF AGREEMENT
this                       DATE                                   in Sta Rita, Pampanga.
Municipal Mayor of Sta. Rita

Signed on behalf of the Primary Care Facility Jovel P. Gangcuangco, MD

Municipal Health Officer
Fleur-de-lis M. Zapanta, MDElizabeth V. Pasinag, RN Hon. Arthur L. Salalila

Elizabeth V. Pasinag, RN
Public Health Nurse
Public Health Nurse

Signed on behalf of the Referral Hospital Fleur-de-lis M. Zapanta, MD

Chief of Hospital
Diosdado P. Macapagal
Memorial Hospital

Signed on behalf of the Municipality of Sta Rita Hon. Arthur L. Salalila

Municipal Health Officer Chief of Hospital Diosdado P. Macapagal Memorial Hospital

Municipal Mayor of Sta Rita

Jovel P. Gangcuangco, MD
 ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES

STA RITA, PAMPANGA

BEFORE ME, a Notary Public and in the above jurisdiction, personally appeared the following:

NAME PRC License

Municipal Mayor of Sta. Rita

Jovel P. Gangcuangco, MD                                                  

Fleur-de-lis M. Zapanta, MD                                                   

Fleur-de-lis M. Zapanta, MDElizabeth V. Pasinag, RN Hon. Arthur L. Salalila

Elizabeth V. Pasinag, RN                                                   

Hon. Arthur L. Salalila                                                   

Public Health Nurse

Known to me and to be the same persons who executed the foregoing instruments, and
acknowledged to me that the same is their voluntary act and deed.

These instruments consisting of four (4) pages, has been signed on the left margin of each and
every page thereof by the parties and their witness and sealed with my notarial seal.

WITNESS MY HAND AND SEAL, this            of                                            , 2022 at Sta Rita,
Municipal Health Officer Chief of Hospital Diosdado P. Macapagal Memorial Hospital

Pampanga, Philippines.

                                                    
NOTARY PUBLIC

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Jovel P. Gangcuangco, MD