-

Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

SEP 15 2011

ADMINISTRATIVE ORDER
No. 2021 -

SUBJECT: Guidelines on Determining Eligibility for Social Care, Medical

and Financial Assistance, and Point of Service

I. BACKGROUND AND RATIONALE

The principle of equity is grounded on Article XIII Section 11 of the 1987 Constitution
that states “The State shall adopt an integrated and comprehensive approach to health
development which shall endeavor to make essential goods, health and other social
services available to all the people at an affordable cost. There shall be a priority for
the needs of the under-privileged, sick, elderly, disabled, women, and children. The
State shall endeavor to provide free medical care to paupers”.

Republic Act (R.A.) No. 11223, the Universal Health Care (UHC) Act, provides for an
integrated and comprehensive approach to ensure a health care model that provides all
Filipinos access to a comprehensive set of quality and cost-effective, promotive,
preventive, curative, rehabilitation and palliative health services without causing
financial hardship, and prioritizes the need of the population who cannot afford such
services. The Act emphasizes the duty of the State to ensure that these services reach
especially those who are financially incapable. One strategy to protect Filipinos from
financial risk is the PhilHealth Point of Service (POS) in which the indigent and the
financially incapable to pay premiums are enrolled based on the evaluation of medical
social workers (MSWs) in health facilities. This was reiterated in PhilHealth Circular
Nos. 2018-0008, Guidelines on the Implementation of Point of Service (POS)
Enrollment Program under the General Appropriations Act (GAA) 2018 onwards and
2019-0010, Guidelines on the Granting of Immediate Eligibility to Members.

R.A. No. 11463, or the Malasakit Centers Act, also provides for a medical and financial
assistance mechanism that complements the implementation of the UHC Act by
ensuring that Filipinos are protected from financial risks when accessing health care
services in
all health facilities.

Both laws require a mechanism to assess the financial capability of patients and identify
the factors influencing patients’ health status. The mechanism forms the core function
of MSWs, who assess the psychosocial functioning of patients, which includes
evaluation of an individual’s physical, mental and emotional health along with their
ability to function within their respective families and communities. All these
contribute to their capacity to meet their basic needs including their financial capability.
This policy provides the standard guidelines in the assessment of eligibility for
assistance.

N 7
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Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL. http://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph
II. OBJECTIVES

This Order aims to:

A. Ensure financial risk protection of the financially incapable or incapacitated, and
poor patients in the progressive implementation of the UHC Act; and

B. Streamline the process and set realistic and objective guidelines for the assessment
of financial capability to access Point of Service (POS), Malasakit Centers’
Financial Assistance, waiver for treatment costs not covered by case rates, and
medical social work intervention for psychosocial concerns.

1. SCOPE AND COVERAGE

This Order shall apply to all government and private hospitals, infirmaries, Drug and
Treatment Rehabilitation Centers (DATRCs), and other health facilities that require
the assessment of a patient's financial capability for social care, financial and medical
assistance and enrollment to POS.

Iv. DEFINITION OF TERMS

A. Basic or Ward Accommodation, refers to the provision of a regular meal, bed in

a shared room, with at least fan ventilation, and shared toilet and bath (UHC IRR
Section 4.3).

B. Complex Patients refer to individuals who have multiple complex medical

conditions, or multiple detrimental social determinants of health, or a combination
of both that contribute to preventable service utilization and poorer overall
healthcare management that ultimately negatively impacts the individuals overall
health status.

C. Direct Contributors refer to those who have the capacity to pay premiums, are
gainfully employed and are bound by an employer-employee relationship, or are
self-earning professional practitioners, migrant workers, including their qualified
dependents, and lifetime members (PhilHealth Circular 2019-0010).

D. Financially Capable refers to a state where a person demonstrates clear ability to

pay premium contributions or spend for necessary expenditures for one’s medical
treatment as assessed and certified by DSWD, medical social workers, or social
worker officers of the LGUs (Philhealth Circular 2019-0010).

E. Financially Incapable refers to a state where a person demonstrates clear inability

to pay premium contributions or spend for necessary expenditures for one’s
medical treatment as assessed and certified by DSWD, medical social workers, or
social worker officers of the LGU (Philhealth Circular 2019-0010).

F. Financially Incapacitated refers to a patient who is not classified as indigent but

who demonstrates clear inability to pay or spend for necessary expenditures for
one’s medical treatment such as patients with catastrophic illness, or any illness

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 that is life or limb-threatening, and requires prolonged hosptalization, extremely
expensive therapies or other special but essential care that would deplete one’s
financial resources, as assessed and certified by the medical social worker
(Malasakit Centers Act IRR Section 3.3).

. Indigent Patient refers to a patient who has no visible means of income, or whose
income is insufficient for the subsistence of his/her family, as assessed by the
Department of Social Welfare and Development (DSWD), local government social
worker, medical social worker of the health facility, or a social worker of any
government entity providing medical and financial assistance (Malasakit Centers
Act IRR Section 3.3).

. Indirect Contributors refer to all others not included as direct contributors, as

well as their qualified dependents, whose premium shall be subsidized by the
national government including those who were subsidized as a result of special
laws (PhilHealth Circular 2019-0010).

Level of Psychosocial Functioning refers to the ability of people to perform the

tasks of daily life, to engage in mutual relationships with other people in ways that
are gratifying to themselves and others, and to meet the need of an organized
community that facilitates their well-being.

Non-Basic Accommodation refers to provision of amenities which are features of

the health service that provide additional comfort or convenience such as private
accommodation, air conditioning, telephone, television, among others (UHC IRR
Section 4.2).

. Per Capita Poverty Threshold (PCPT) refers to the minimum income required for
a family/individual to satisfy essential nutritional requirements (i.e., 2,000
kilocalories) and other basic needs as updated by the Philippine Statistical
Authority.

. Social Care refers to the provision of personal care, supporting individuals with
tasks of daily living and supporting people to engage with their communities.

. Vulnerable Population refers to patients who are indigenous peoples, women,

children, elderly, socioeconomically disadvantaged, in a population in a crisis
situation, uninsured, or those with certain medical conditions. Members
of vulnerable populations often have health conditions that are exacerbated by
unnecessarily inadequate healthcare.

. Waivers are a right conferred to an individual that entitles him or her to obtain
health services in certain health facilities at no direct charge or at a reduced cost.
They are subjected to the Medical Social Worker (MSW) assessment to determine
their financial incapacity, their subcategory to determine their appropriate
percentage of waiver/ discount (see Annex C). The subjects of waivers are
individuals. The existence of waivers in a health system implies that the system
will discriminate between waiver holders and the rest of the population. By
reducing the out-of-pocket cost of care to beneficiaries, waivers seek to improve
both equities in access and equity in the financing of health services.

7 Gr
V. GENERAL GUIDELINES

A. All health facilities through their Medical Social Work Department (MSWD) shall
adopt the
prescribed classification of patients according to financial condition that
will be utilized in the following procedures/ processes:
Enrollment to Point of Service (POS);
Access to Medical and Financial Assistance through the Malasakit Center;
IRAE
Prioritization for admission to Basic or Ward Accommodation;
Waiver System on Medical Services not covered by case rates;
Social Care; and
Other services deemed applicable.

B. All health facilities shall strive to ensure the availability of medicines, medical
devices (including implants), diagnostic imaging and laboratory test to ensure that
no other fees or expenses are charged to patients classified as indigent/ financially
incapable or financially incapacitated as defined in this Order.

C. All health facilities shall maintain standard length of stay through the
establishment of a pre-admission planning system, under the MSWD that shall
ensure the following:
1. Prompt identification of vulnerable patients requiring contact, coordination,
and referral among doctors, nurses, admitting personnel and MSWs;
2. Cost-effective and medically necessary care provided by healthcare team with
appropriate referral done, as needed;
3. Psychosocial issues of admission addressed through referral and outreach
planning; and
4. Planned follow-up care after discharge.

D. Infirmaries may coordinate with a Local Social Welfare Office to perform the
classification.

E. DATRC:s shall adopt the process for evaluating a patient's financial capability for
services where the waiver system for medical services and social care is
applicable.

VI. SPECIFIC GUIDELINES

A. Streamlining of definitions
1. In order to streamline the definitions from different policies relative to patient
classification, the following classification shall now be adopted:

+) 4
 Old Old Classification New Classification New
Classification AO 315.2015 Malasakit Center Classification
AO 515.2010 POS
D Indigent/ poor Indigent Financially
C3 (Patient monthly Incapable
per capita income is (Patient month!
c3 .
Partial Payment
equal to or below
income
per capita
140% of the PCPT) is equal to or
below 220% of
C2 Financially PCPT)
Incapacitated
C2 (Patient monthly
cl per capita income is
above 140% of the
PCPT but not more
than 180%)

C1 (Patient monthly
per capita income is
above 180% of the
PCPT but not more
than 220%)

B Full Payment Financially Financially

Capacitated (Patient Capable (Patient
monthly per capita monthly per capita
A income is above 220% income is above
of the PCPT) 220% of the
PCPT)

2. All MSWs shall evaluate and classify the financial capability as provided by
existing policies based on the Household Monthly Per Capita Income and
Monthly Per Capita Poverty Threshold (PCPT). This process of computation
is further provided in Annex A.

3. A waiver system shall be applied for admission, Outpatient Department (OPD)

treatment and procedures not covered by the PhilHealth package. The MSW
shall evaluate patients as Financially Incapable, if the patient has a monthly
per capita income that is equal to or below 220% of the PCPT for the region
where the hospital is located. The Financially Incapable patients shall further
be classified into the following categories and provided socialized fees as
shown in (Annex C):
a. C1 - Patient whose monthly income per capita is above 180% but not
more than 220% of the latest PCPT for the region where the hospital is
located;
b. C2 - Patient whose monthly income per capita is above 140% but not
more than the 180% of the latest PCPT for the region where the hospital
is located; and
c. C3 - Patient whose monthly income per capita is below 140% of the
latest PCPT for the region where the hospital is located.

AY
 The income indicators for indigent, financially incapable and incapacitated
shall be supported by any of the following criteria;
a. Patient having a severity index of moderate to catastrophic in level of
social functioning and/or economic basic needs system based on the
Person in Environment Framework as referenced in the latest edition of
the Manual for Medical Social Workers;
b. Patient has any of the following modifiers arising from specific
situations or circumstances:
i. Belongs to the vulnerable population as defined in this Order;
ii. Has personal circumstances such as crisis situation, disability,
absence of social support system, orphans, elderly, solo parent,
complex condition;
ili. In community situations such as informal settlers, internally
displaced persons due to natural or man-made disasters, armed
conflicts, or belonging to an economically disadvantaged or
marginalized ethnic group, when treatment cost is more than
their household income, and is arising from chronic illness or
disability; and
iv. Identified as a complex patient as defined in this Order;

The MSW shall evaluate patients as Financially Capable if the following are
met:
a. Household monthly per capita income is higher than 220% of the PCPT;
and
b. Patients having a severity index of no problem to low in social
functioning and/or economic basic needs system based on the Person in
Environment Framework as referenced in the latest edition of the
Manual for Medical Social Workers.

B. Allhealth facilities specified hereunder shall incorporate the following respective

changes in their operations, as deemed applicable or appropriate:

1. The MSWs shall utilize the MSW Assessment Form (Annex B) to determine
the financial capability/capacity and the psychosocial functioning of the patient
and his/her family and the criteria stated above. The form based on the
Psychosocial Assessment Framework, was structured to solicit and validate
information in a therapeutic manner. The assessment shall help the MSWs to
provide the appropriate interventions for the patients and their families.
Interventions may include the following:
a. Crisis intervention;
b. Individual or family counseling;
c. Social case management; and
d. Group work.

All patients admitted in the basic ward shall be referred to the Malasakit Center
using the Certificate of Eligibility, which shall be the official document
required to avail of services in the Malasakit Center. Assessment tools can be
attached or data shall be transcribed electronically in the Unified Intake Sheet.
(DOH-DSWD-PCSO-PHIC JAO No. 2020-0001, Operational Guidelines for the
Implementation of the Medical and Financial Assistance to Indigent and Financially-

\
Incapacitated Patients pursuant to Republic Act No. 11463 also known as “Malasakit
Centers Act of 2019”)

The MSWs shall conduct these assessments within 72 hours upon admission,
except during pandemics or disasters. Elective cases may be assessed before
admission as part of the pre-admission planning process.

The MSWs classification shall be applicable in 6 months to one year depending

on the length of treatment. Reassessment of patient’s classification during the
course of the admission or treatment may be allowed if deemed appropriate
and necessary based on the modifiers stated in this Order.

All health facilities shall do the following upon the assessment

financial capability, as deemed applicable or appropriate:
of the patient’s

a. Prioritize the financially incapable/ indigent and incapacitated in the

admission to basic or ward accommodation;
b. Enroll non-PhilHealth members and inactive direct PhilHealth
contributors assessed as financially incapable to the POS;
c. Advise non-PhilHealth members and inactive direct contributors
assessed as financially capable to enroll as direct contributors, or update
their premiums to the nearest local PhilHealth office;
d. Counsel and mediate patients who refuse to be enrolled in the POS,
particularly for medico-legal cases;
e. Charge co-payment for services, professional fees, and amenities based
on the co-payment guidelines issued by PhilHealth, regardless of
membership type, to patients who opt to avail of or be transferred to a
non-basic accommodation;
f. Assign a MSW in the ward and specialty centers that shall serve as a
case manager to complex patients, and the said case manager shall
arrange, coordinate, plan, advocate, and monitor multiple services in the
facility to provide the individual patient’s health and social needs
g. Particular to patients requiring outpatient services, patients provided
with ambulatory care rendered at the Emergency Department, and
patients requiring treatment, procedure or diagnostics not covered by
any PhilHealth package:
i. Financially incapacitated patient shall be referred to the
Malasakit Center for financial assistance, or shall be encouraged
to participate in their treatment cost based on their capability to
pay for socialized fee matrix (see Annex C); and
ii. Financially capable patients shall cover the excess of the
PhilHealth case rate package.
h. Report indirect contributors assessed as financially capable as part of
feedback to PhilHealth and DSWD;
i. All private attending physicians shall discuss the possible cost of
treatment to their patients or shall refer their patients to the designated
Financial Counsellor, the Billing Section, or the MSW for financial
counseling.
j. Emergency patients as defined in RA 10932 or the Anti-Hospital
Deposit Law, shall utilize existing mechanisms for medical and financial
assistance to cover for these services subject to existing guidelines.

7 b Ay
 6. Health facilities shall ensure that patients are referred to the appropriate facility
to reduce inappropriate admissions and ensure appropriate use of medical and
financial assistance.

VII. ROLES AND RESPONSIBILITIES

A. Philippine Health Insurance Corporation (PhilHealth)

1. Review current mechanisms/ process to validate membership to streamline
requirements (See Annex D); and
2. Adopt these guidelines in their process for enrolling patients in POS.

Field Implementation and Coordination Teams

1. Shall advocate for the implementation of this Order with the health facilities
under their respective cluster areas; and
2. Ensure monitoring of the policy implementation.

Health Facility Development Bureau (HFDB)

1. Develop a monitoring system to be implemented through the Centers for
Health Development (CHDs);
2. Develop a standard template for reporting the implementation of this policy;
3. Provide technical assistance in the interpretation of this policy and the
utilization of the standard psychosocial assessment tool;
4. Release an annual report on the compliance of these guidelines;
5. Evaluate the impact of the policy after three years of implementation; and
6. Advocate for the appropriate budget allocation for the health facilities.

Malasakit Program Office (MPO)

1. Adopt this Order for assessing financial capability of patients
2. Participate in the development of a monitoring system.
in its guidelines.
Centers for Health Development (CHDs)
1. Ensure the compliance in the implementation of the policy through information
dissemination activities and technical assistance by their respective Health
Facility Development Units (HFDUs);
Capacitate the MSWs in the health facilities in implementing the policy in
coordination with HFDB’s certified resource speakers; and
Monitor the implementation of the policy in all health facilities in the region
and submit a report to the HFDB using a standard template.

Ministry of Health - Bangsamoro Autonomous Region of Muslim Mindanao

(MOH-BARMM)
1. Ensure the implementation of the policy through information dissemination
activities and technical assistance by its Health Facility Development Unit
(HFDU);
Capacitate the MSWs in the health facilities in implementing the policy in
coordination with HFDB’s certified resource speakers; and
Monitor the implementation of the policy in all health facilities in the region
and submit a report to the HFDB using a standard template.

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 G. Health facilities
1.Require the Medical Social Work Department (MSWD) to formulate an
institutional policy that reflects both the PCPT of the region where the health
facility is located and the unique needs of the health facility;
2. Ensure the conduct of the following through the MSWD:
a. Assessment to identify the financially incapable and capable using the
guidelines herein;
b. Enrollment of non-PhilHealth members assessed as financially
incapable and incapacitated are enrolled on the POS, while the
financially capable are motivated to pay the PhilHealth premium; and
c. Provide the necessary psychosocial support or intervention to patients
based on evaluation.
3. Submit standard monthly reports of classified patients, annual statistical
reports, narrative reports, and psychosocial profile of patients to the HFDB as
prescribed by the Manual for Medical Social Workers and reports mandated
by the MPO.
4. Require the Hospital Finance Service to monitor quantified free services
arising from the implementation of the policy.

H. Local Government Units (LGUs)

1. Monitor implementation among the health facilities under its management; and
2. Adopt this policy in enrolling the uninsured on the POS for the Health Care
Provider Network. In identifying the financially incapable, the HCPN shall
either utilize the DSWD Listahanan, assessment of MSWs in the health
facilities, and the assessment of the local social worker when facilities are
without MSW. An assessment can be applied and shared within the HCPN for
one year. Reassessment can be done after one year, or
validation.
if there is a cause for

VIII. MONITORING AND EVALUATION

The HFDB in coordination with the MPO, FICT, and CHDs shall develop a monitoring
system to determine compliance with the policy. The system shall include monitoring the
cost of the implementation, which shall serve as one of the basis for PhilHealth’s review
of case rates, and DOH and LGU reviews of budget allocation for the health facilities.

An annual report shall be consolidated to determine the improvement of accessibility of

the poor and vulnerable population, and identify the social determinants of health used as
modifiers, profile of the financially incapable, and the cost of assistance provided.

IX. REPEALING CLAUSE

The DOH Administrative Order No. 2015-0031, Amended Guidelines for the
Implementation of Republic Act No. 747 entitled “An Act To Regulate The Fees To Be
Charged Against Patients In Government Hospitals And Charity Clinics Classifying
Patients According To Their Financial Condition” is hereby repealed. Provisions of other
administrative issuances inconsistent with this Order are also repealed, superseded, or
modified accordingly.

9
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 X. SEPARABILITY CLAUSE

If any clause, sentence, or provision of this Order shall be declared invalid or

unconstitutional, the other provisions not affected thereby shall remain valid and effective.

XL INTERPRETATION

Any doubt or inconsistency in the interpretation of this Order shall be resolved in a manner
that will serve the purpose of this Order.

XII. EFFECTIVITY CLAUSE

This Order shall take effect fifteen (15) days upon publication to the Official Gazette or
in any newspaper of general circulation and upon registration to the Office of the National
Administrative Register, University of the Philippines.

SCO DUQUE
¥.

III,
Sglretary of Health
MD, MSc

10
ANNEX A. Computation for Comparing the Monthly per Capita Income and monthly
PCPT

A. All MSWs shall use the Monthly per Capita Income and monthly PCPT as the main
determinant in classifying patients in terms of financial capability through the following
steps:

1. Determine the Household Monthly per Capita Income through the following
equation:
(Sum of all income of each household member)
Household Monthly per Capita Income = Total number of all household members

Determine the 220%, 180% and the 140% cut off value for the Monthly per
capita Poverty Threshold as updated by the Philippine Statistics authority per
region where the concerned health facility is located using the following
equation:

(Annual per Capital Poverty Threshold in the Region)

Monthly per Capita Poverty Threshold = * (% cutoffvalue)
12

Compare the Household Monthly per Capita Income with the cut-off values for
the Monthly per Capita Poverty Threshold.

Household Monthly per Capita Classification

Income

< the 140% value for the Monthly Indigent

per capita Poverty Threshold

>140% but <220 % value for the Financially Incapacitated

Monthly per capita Poverty
Threshold.

Specifically for Socialized Fees Specifically for Socialized Fees

> 180% but <220% C1
>140% but < 180% C2
<140% C3

> 220% value for the Monthly per Financially Capable

capita Poverty Threshold

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B. Sample Computation:
Location: National Capital Region
Monthly per Capita Income: PHP 4,500
Annual Per Capita Threshold: 28, 628 Based on the 2019 PSA Report

(Annual per Capital Poverty Threshold in the Region)

Monthly per Capita Poverty Threshold = « (% cutof fralue)
12

Computation for the cut-off values

Cut-off Values PHP

220% 5,248.46

180% 4,294.20

140% 3,339.93

Assessment: The patient is assessed as financially incapacitated (C1) given that it falls
between 180% and 220% cut-off.
ANNEX B MSWD Assessment Tool
Form
Ooo re of To HAUT
DROYYRrL
Pruhiopirds
Of

NI OF MLDS
ABAD As30z5r oR Tous

Date of Admitsion/Consuttation’ Batic Ward Batik Ward

[ Spexity} Spexity)

Contact Number

w 0
Type of Lhng Arrangement (Check
Rert
EGuCaDONI] Ataniment Phi Hevlth Membenthip MSWD

nancy

of
Fisherfoly Disasters ang

Status Retasonship to Patere [Sucational

Sources of income TOTAL IMCOME

Subdassihication for For OPD Patents

source
Eecrcity Kerosene? Candle

ransportati [Househelp

Medal
Dragnosis. nal Diagnosis ( Upon Dscharge)

of the Symptoms [Treatment prior 10 admision Previous treatment and dur ston

Treatment Plan Accotudikty Problem

boa
ll.
ASSESSMENT OF SOCIAL FUNCTIONING
1. FAMILIAL TYPE OFSOCIALINTERACTION SEVERITY INDEX DURATION INDEX COPING INDEX
ROLEzS PROBLEM 1. No problem 1. More than five years 4. Outstanding
1. POWER 2. Low 2. One to five years 2. Above average
2. AMBIVALENCE 3. Moderate 3. Six gosto one yr 3. Adequate
3. RESPONSIBILITY 4. High 4. Oneto six mas 4. Somewhat
4. DEPENDENCY 5. Very High 5S. Two weeks to one inadequate
6. Catastrophic month 5. Inadequate
3. Loss
OLA TION 6. less than two wks. 6. No coping "9 skills
7. VICTIMIZATION
s. MIXED
9. OTHERS
PARENT 12] 3lalslelz]slol1}2|3]a|ls|s]1]|2|3|ajs|e]1]|]2]3]4|5]s
SPOUSE sl
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CHILD 1]
2]3lalslej7]elolal2lz|lals|elasja|s|als|e|s]j2]3|a]s]s
SIBLING 1|2l3lalsl{el7]slol1i2]2]a|ls|le|ls|2]3|ajs|{e]1]|2]3{a]5]6
OTHER FAMILY
MEMBER
sl
2[3lalslel7]e]lol1]2]l3jals|e|l1]|2]3]a|ls|ejr]|2]3|aj5]e
SIGNIFICANT
OTHERS
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2. OTHER
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Member sl
20alalsielzlelsal1]l2]la3lals]el1]2]3|a]s5]ef1]2]3]s|[S|s
Other (Specify) al2l3lalslel7lslel1|l2]l3]lafjsiel1|2|3]a|s|e]|]1]|2{3]a]5]s
3.OCCUPATIONAL
ROLES ala2l3lalsielzlelolsla|a|lals]e]t1]2]3]a]|sje|1|2]3]4]5]F€
Worker-Paid
Economy il2lzlalsle|l7ialsl1]|2|l2|lalsjel1|2|3fa]|s|e]|1|2]{3]a]S]|e
Worker — Home sl
2laslalslelz]e]lsls|2|2lals]efja]z]{a|alsje]r1]2|3]8]5]|¢€
Workervolonteer 1] 2] 3 als|s|7fe]sl1]2]s|lajs|je|{1]|2|3jsaf{s5]|e]1]2]{3]|4]|5]|6
Student lal alalsfe]z]s]ols|2|3|a]s]e|s]2a|a]a|s]6]1]2]|3]4|5]|F€
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3. SPECIAL LIFE
SITUATION
ROLES
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Consumer al2lalalslelzlelsl1]|2]3|als]els]2fla|a]sje]1|2f3]a]5]6
Inpatient/Client
al2latlalslelzlslofjrlalz|ajsis|l1]2|a|ja]s|e]r]|2j3[a|s5]6
Outpatientictient 1|
2|3|a|s|sj7]s|o]1|2]s|afs|e|1]|2|3]a]|s5]|6j1]2]{3]4]5]6€
il 2lalalslelz]ls]lsls|2fjala|ls)s|s]2]3|af|sje]1]2|3]a]5]F¢€
Prisoner al2l3]als|el7zlelsls]2{3|e|s]6]v]2j3]a|s5]|6)1[2]3]a]5]6
Immigrant-legal sl2laslalslelz]|elol1]2|s|als]s|s]|2]s]ajsjelr]|2]3]s]5(6e
immigrantillegal (1
| al|s|e|7|8|9]1]|2|3]|a|s|s]1]|2|2}a]|s|e|lri2]3]a[5]6
31

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refugee
—

al2lalalslejz]alsla|2la|a]ls|e]1|2fs|a|ls|es]jr]2]3[5]5]F%
Other{specify) il 2l3lals|el7|slsf1l2]3]als]els]2]{3|afjsie]1]|]2]|3][5]|5]|¢e
NO SOCIAL INTERACTION PROBLEM
IV.PROBLEMS IN THE ENVIRONMENT: SEVERITY INDEX DURATION INDEX
A. ECONOMIC/ BASIC NEEDS SYSTEMS 1. No problem 1. More than five years
PROBLEMS. 2. Low
3. Moderate
2. to five years
One
3. Six mos. to one y{
4. High 4. One to six mos.
§. Very High 5. Two weeks to one month
§. Catastrophic 6. less than two wks
1. FOOD AND NUTRITION
Lack of regular food supply 1 2 3 4 § 6 1 2 3 4 5 6
Nutritionally inadequate food supply 1 2 3 4 S$
6 1 2 3 4 5 6

Documented malnutrition 1 2 3 4 5 6 1 2 3 4 5 6
Other (specify) 1 2 3 4 3S
6 1 2 3 4 5 6
2. SHELTER
Absence of shelter 1 2 3 4 5 6 1 3 4 5 6
Substandard or inadequate shelter 1 2 3 4 5 6 1 4 6
Other (specify) 1 3 4 5 6 1 2 4 6

458)
3. EMPLOYMENT
Unemployment, employment is not
available in the community
Underemployment, adequate employment is
1]
23s] 1]

2]3]|]4]5]FE
1 2 3 4 5 6 1 2 3 4 5 §
not available in the community.
Inappropriate employment, Lack of
sociallyllegally acceptable employment in the 1 2 3 4 $ 6 1 2 3 4 5 6
community.
Others {specify) 1 2 3 4 5 6 1 2 3 4 5 6
4. ECONOMIC RESOURCES
Insufficient community resources for basic 4 5 6 2 3 4 5 8
1 2 3 1
sustenance
Insufficient resources in the community to
provide for needed services beyond 1 2 3 4 $ 6 1 2 3 4 5 6
sustenance
Other (specify) 1 2 3 4 5 6 1 2 3 4 S$ 6
5. TRANSPORTATION
No personal public transportation to jobs 4 5 6 2 3 4 5 6
1 2 3 1
needed setvices
Other (specify) 1 2 3 4 S 6 1 2 3 4 5 6
IN ECONOMIC! BA SIC NEEDS
No eauBLEMS 1 2 3 4 5 6 1 2 3 4 5 6
B. AFFECTIONAL SUPPORT SYSTEM
Absence of affectional support system 1 2 3 4 5 6 1 2 3 4 5 6

Support system inadequate to meet affectional 9 2 3 4 5 6 1 2 3 4 5 6

needs
Excessively involved support system 1 2 3 4 5 6 1 2 3 4 $ 6

Others (specify) 1 2 3 4 $ 6 1 2 3 4 5 6

ASSESSMENT FINDINGS RECOMMENDED INTERVENTIONS

Patient’s Signature Medical Social Worker

G4
ANNEX C Modes of Cost Sharing

Patient Accommodation Government Subsidy Level Patient

Classification Share

Financially Non-Basic 0% on PhilHealth excess 100%

capable

OP Private Clinics 0% on PhilHealth excess and non-package treatment 100%

Emergency Room 0% on PhilHealth excess and non-package services 0 to 100%

TC Dorm and 0% on PhilHealth excess and non-package services 100%

Aftercare

Financially Basic 100% in excess of PhilHealth package and difference 0%

Incapable’ charge to the available funds in the Malasakit Center
Indigent following order of charging ( DM No 2020-0192)

OPD 100% in excess of the PhilHealth package or charge 0%

to available funds in the Malasakit Center.

Emergency Room 100% in excess of PhilHealth package and non- 0%

package services
Malasakit Center
orcharge to available Funds in the

TC Dorm and 100% in excess of the PhilHealth package . If no 0 to 50%

Aftercare package use the socialized fees:
C1-50%
C2- 75%
C3 - 100%

Financially Basic 100% in excess of PhilHealth package and difference 0%

incapacitated charge to the available funds in the Malasakit Center
following order of charging ( DM No 2020-0192)

OPD 100% in excess of the PhilHealth package or charge 0% to 50%

to available funds in the Malasakit Center. If no
available funds use the socialized fees:
C1 -50%
C2- 75%
C3 - 100%

Emergency Room 100% in excess of PhilHealth package and non- 0%

package services or charge to available Funds in the
Malasakit Center

TC Dorm and 100% in excess of the PhilHealth package . If no 0 to 50%

Aftercare package use the socialized fees:
C1 -50%
C2- 75%
C3 - 100%

4) Tr
ANNEX D

Requirements of PhilHealth Point of Service Enrollment

MSWD Assessment Tool
DWN
Birth Certificate to verify the correct name, middle name, surname, and birthday
Newborn Birth certificates
The marriage certificate verifies the married name
In the absence of Birth Certificate, 2 valid government-issued IDs

WORN
if
Signature of the father
Certificate of no marriage
his PhilHealth is utilize

Affidavit of two disinterested persons for wrong spelling

For IP patients, additional requirements from National Council for Indigenous People (NCIP) to
validate the information

Requirements of PCSO in Malasakit Center

(JAO No. 2020-0001, Operational Guidelines for the Implementation of the Medical and Financial
Assistance to Indigent and Financially-Incapacitated Patients pursuant to Republic Act 11463 also
known as “Malasakit Centers Act of 2019”)

Confinement — statement of account (SOA)

BN
Chemotherapy — treatment protocol, prescription and official quotation
Hemodialysis — Certificate on the Number of Availed Sessions from PhilHealth and official
price quotation
Erythropoietin injection, Hemophilia and Post-transplant medicine — medical certificate,
prescription and official price quotation

Requirements of DSWD in Malasakit Center (JAO No. 2020-0001)

Photocopy of a valid government issued ID or other legitimate proof of identity

WN Official price quotation of General Assistive Devices
Funeral Contract (except for Muslim and Indigenous People performing customary practices);
Death Certificate or Certification from the tribal Chieftain (for IPs), Imam (for Moro) or Doctor
or authorized medical practitioner, in the absence of a death certificate; and Transfer Permit
(except for Moro and Indigenous Peoples performing customary practices), if applicable.
Original Unified Intake Sheet and Certificate of Eligibility

Requirements for DOH Medical Assistance (JAO No. 2020-0001)

Medical Certificate and/or Medical Abstract
wn Certificate of Indigency
Drug or Medicine Prescription or Treatment Protocol, as applicable
Lh
Laboratory or Diagnostic Request
Hospital Bill

Requirement for Social Care

MSWD Assessment tool

V Ue