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Republic of the Philippines Department of Health OFFICE OF THE SECRETARY SEP 15 2011 ADMINISTRATIVE ORDER No. 2021 - SUBJECT: I. Guidelines on Determining Eligibility for Social Care, Medical and Financial Assistance, and Point of Service 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 all health facilities. in 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 Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 loc 1113, 1108, 1135 Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL. http://www.doh.gov.ph; e-mail: [email protected] 7 | 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 >) 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 prescribed classification of patients according to financial condition that the will be utilized in the following procedures/ processes: Enrollment to Point of Service (POS); Access to Medical and Financial Assistance through the Malasakit Center; 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. IRAE 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. 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. C. All D. Infirmaries may coordinate with a Local Social Welfare Office to perform the classification. E. VI. 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. 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 Classification AO 515.2010 D c3 Old Classification AO 315.2015 New Classification Malasakit Center Classification POS Indigent/ poor Indigent C3 (Patient monthly per capita income is equal to or below 140% of the PCPT) Financially . Partial Payment C2 Financially Incapacitated C2 (Patient monthly per capita income is above 140% of the PCPT but not more than 180%) cl New Incapable (Patient month! income per capita is equal to or below 220% of PCPT) C1 (Patient monthly per capita income is above 180% of the PCPT but not more than 220%) B A Full Payment Financially Capacitated (Patient monthly per capita income is above 220% of the PCPT) Financially Capable (Patient monthly per capita income is above 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 the patient has a monthly shall evaluate patients as Financially Incapable, 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. if 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: 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. a. B. All health 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. of All health facilities shall do the following upon the assessment the patient’s financial capability, as deemed applicable or appropriate: 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 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. to 7 b Ay 6. VII. 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. ROLES AND RESPONSIBILITIES A. Philippine Health Insurance Corporation (PhilHealth) 1. 2. Review current mechanisms/ process to validate membership to streamline requirements (See Annex D); and 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) Adopt this Order for assessing financial capability of patients 2. Participate in the development of a monitoring system. 1. in its guidelines. Centers for Health Development (CHDs) 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. 1. 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. sf) G. Health facilities 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. 1. H. Local Government Units (LGUs) 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 there is a cause for one year. Reassessment can be done after one year, or validation. 1. if 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 Ce 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. III, DUQUE SCO MD, MSc Sglretary of Health ¥. 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: Household Monthly per Capita Income = (Sum of all income of each household member) 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: Monthly per Capita Poverty Threshold = (Annual per Capital Poverty Threshold in the Region) * 12 (% cutoffvalue) Compare the Household Monthly per Capita Income with the cut-off values for the Monthly per Capita Poverty Threshold. Classification Household Monthly per Capita Income < the 140% value for the Monthly per capita Poverty Threshold Indigent >140% but <220 % value for the Monthly per capita Poverty Threshold. Financially Incapacitated Specifically for Socialized Fees > 180% but <220% >140% but < 180% <140% > 220% value for the Monthly per capita Poverty Threshold Specifically for Socialized Fees C1 C2 C3 Financially Capable Nh 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 Monthly per Capita Poverty Threshold = (Annual per Capital Poverty Threshold in the Region) « 12 (% cutof fralue) 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 between 180% and 220% cut-off. it falls ANNEX B MSWD Assessment Tool Form Pruhiopirds re of To HAUT Ooo DROYYRrL Of NI OF MLDS ABAD Date of Admitsion/Consuttation’ As30z5r oR Tous Batic Ward Batik Spexity} Spexity) [ Ward Contact Number w 0 Type of Lhng Arrangement (Check Rert EGuCaDONI] Ataniment Phi Hevlth Membenthip MSWD nancy of Disasters ang Fisherfoly Status Sources of income Retasonship to Patere [Sucational TOTAL IMCOME Subdassihication for For OPD Patents source Eecrcity Kerosene? Candle ransportati [Househelp Medal Dragnosis. of the Symptoms [Treatment prior 10 admision Treatment Plan nal Diagnosis ( Upon Dscharge) Previous treatment and dur ston Accotudikty Problem boa ll. ASSESSMENT OF SOCIAL FUNCTIONING TYPE OFSOCIALINTERACTION 1. FAMILIAL ROLEzS PROBLEM 1. POWER AMBIVALENCE 2. RESPONSIBILITY 3. DEPENDENCY 4. 3. Loss OLA TION 7. 12] SPOUSE sl CHILD 1] OTHERS 2. OTHER interPersoNAL ROLES Lover Friend Neighbor Member Other (Specify) 3.OCCUPATIONAL ROLES Worker-Paid Economy 2] 5. 6. 3 als|s|7fe]sl1]2]s|lajs|je|{1]|2|3jsaf{s5]|e]1]2]{3]|4]|5]|6 lal alalsfe]z]s]ols|2|3|a]s]e|s]2a|a]a|s]6]1]2]|3]4|5]|F€ 2|3|4|5|s|7]|8|9ofj1)2]3s|afs|e|1]|2]|3]a]5]6]1]2]/3]4]S5]6€ al2]aslalslelzla)ol1]|2|ls|als]|e|r]2|3]a|s5|e}j1]2]3]|a|[S]|e6 1] SITUATION Outpatientictient month less than two wks. Somewhat sl 3. SPECIAL LIFE Inpatient/Client 6. inadequate Inadequate No coping "9 skills 4. sl 1] Consumer Catastrophic Oneto six mas Two weeks to one Outstanding Above average Adequate 2] 1] Workervolonteer ROLES 6. 5S. Six gosto one yr 4. 2. 3. il sl Others(specify) 5. One to five years sl Worker — Home Student 4. 2. 3. 4. 3lalslelz]slol1}2|3]a|ls|s]1]|2|3|ajs|e]1]|]2]3]4|5]s 2lalalslelzls]lsla|l2|2|a)s]{e]la]2|3|a|s]ej1]2]3|a]5]s 2]3lalslej7]elolal2lz|lals|elasja|s|als|e|s]j2]3|a]s]s 1|2l3lalsl{el7]slol1i2]2]a|ls|le|ls|2]3|ajs|{e]1]|2]3{a]5]6 2[3lalslel7]e]lol1]2]l3jals|e|l1]|2]3]a|ls|ejr]|2]3|aj5]e 213lalslselzlslel1l2]lslafsfje]s]|2|3|a]s]e]1]|]2j3|{a]|5]s 3|alsfel7)s]|o]1|2|3|a]s]e]s|2]3]a|s|e}1]2]3]a]5]|F¢ al2l3lalslel7]elofj1]2a{z]ajs|e]1]2]|3|a]s5]6]1]2]3]a|ls]s 2l3lalslelz|s|ola]2lz|als]e]a|2]3]a|s]|e|1]2]3]a]|s5]e 1l2l3lals|el7ls]elal2]3|lajs|el1]2|3|a]s]|e]1j2]3|a]|5]s 20alalsielzlelsal1]l2]la3lals]el1]2]3|a]s5]ef1]2]3]s|[S|s al2l3lalslel7lslel1|l2]l3]lafjsiel1|2|3]a|s|e]|]1]|2{3]a]5]s ala2l3lalsielzlelolsla|a|lals]e]t1]2]3]a]|sje|1|2]3]4]5]F€ il2lzlalsle|l7ialsl1]|2|l2|lalsjel1|2|3fa]|s|e]|1|2]{3]a]S]|e 2laslalslelz]e]lsls|2|2lals]efja]z]{a|alsje]r1]2|3]8]5]|¢€ PARENT MEMBER SIGNIFICANT 3. Low Moderate High Very High COPING INDEX OTHERS 9. SIBLING 2. DURATION INDEX 1. More than five years VICTIMIZATION MIXED s. OTHER FAMILY SEVERITY INDEX 1. No problem al2lalalslelzlelsl1]|2]3|als]els]2fla|a]sje]1|2f3]a]5]6 al2latlalslelzlslofjrlalz|ajsis|l1]2|a|ja]s|e]r]|2j3[a|s5]6 1| il 2|3|a|s|sj7]s|o]1|2]s|afs|e|1]|2|3]a]|s5]|6j1]2]{3]4]5]6€ 2lalalslelz]ls]lsls|2fjala|ls)s|s]2]3|af|sje]1]2|3]a]5]F¢€ refugee al2l3]als|el7zlelsls]2{3|e|s]6]v]2j3]a|s5]|6)1[2]3]a]5]6 sl2laslalslelz]|elol1]2|s|als]s|s]|2]s]ajsjelr]|2]3]s]5(6e al|s|e|7|8|9]1]|2|3]|a|s|s]1]|2|2}a]|s|e|lri2]3]a[5]6 | al2lalalslejz]alsla|2la|a]ls|e]1|2fs|a|ls|es]jr]2]3[5]5]F% Other{specify) il Prisoner Immigrant-legal immigrantillegal Immigrant — (1 31 2l3lals|el7|slsf1l2]3]als]els]2]{3|afjsie]1]|]2]|3][5]|5]|¢e NO SOCIAL INTERACTION PROBLEM IV. PROBLEMS IN THE ENVIRONMENT: A. ECONOMIC/ BASIC NEEDS SYSTEMS PROBLEMS. DURATION INDEX 1. More than years SEVERITY INDEX 1. No problem 2. Low five to five years 3. Six mos. to one y{ 2. One 3. Moderate 4. High §. Very High §. Catastrophic 4. One to six mos. 5. Two weeks to one month 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 6 Other (specify) 2 3 4 3S 6 1 3 4 4 5 1 5 6 1 2 3 5 6 1 3 4 5 1 2 5 6 1 5 6 1 458) 1] 2]3]|]4]5]FE 2 2. SHELTER 6 3 4 4 1 3 4 1] 23s] 1 2 3 4 5 6 1 2 3 4 5 § 1 2 3 4 $ 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 8 1 2 3 4 $ 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 S$ 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 S 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 Absence of affectional support system 1 2 3 4 5 6 1 2 3 4 5 6 Support system inadequate to meet affectional needs 9 2 3 4 5 6 1 2 3 4 5 6 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 Absence of shelter Substandard or inadequate shelter Other (specify) 3. EMPLOYMENT Unemployment, employment is not available in the community Underemployment, adequate employment is not available in the community. Inappropriate employment, Lack of sociallyllegally acceptable employment in the community. Others {specify) 4. ECONOMIC RESOURCES Insufficient community resources for basic sustenance Insufficient resources in the community to provide for needed services beyond sustenance Other (specify) 5. TRANSPORTATION No personal public transportation to jobs needed setvices Other (specify) No eauBLEMS IN ECONOMIC! BA SIC NEEDS B. AFFECTIONAL 2 4 6 4 6 SUPPORT SYSTEM ASSESSMENT FINDINGS RECOMMENDED Patient’s Signature INTERVENTIONS Medical Social Worker G4 ANNEX C Patient Modes of Cost Sharing Accommodation Financially capable Financially Incapable’ Indigent Patient Government Subsidy Level Classification Share Non-Basic 0% on PhilHealth excess 100% 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 Aftercare 0% on PhilHealth excess and non-package services 100% Basic 100% in excess of PhilHealth package and difference charge to the available funds in the Malasakit Center following order of charging ( DM No 2020-0192) 0% OPD 100% in excess of the PhilHealth package or charge to available funds in the Malasakit Center. 0% Emergency Room 100% in excess of PhilHealth package and noncharge to available Funds in the package services Malasakit Center 0% TC Dorm and Aftercare 100% in excess of the PhilHealth package . If no package use the socialized fees: 0 to 50% or C1-50% C2- 75% C3 - 100% Financially Basic 100% in excess of PhilHealth package and difference charge to the available funds in the Malasakit Center following order of charging ( DM No 2020-0192) 0% OPD 100% in excess of the PhilHealth package or charge to available funds in the Malasakit Center. If no available funds use the socialized fees: 0% to 50% incapacitated C1 -50% C2- 75% C3 - 100% Emergency Room TC Dorm and Aftercare 100% in excess of PhilHealth package and non- 0% 100% in excess of the PhilHealth package . If no package use the socialized fees: 0 to 50% package services or charge to available Funds Malasakit Center in the C1 -50% C2- 75% C3 - 100% 4) Tr ANNEX D Requirements of PhilHealth Point of Service Enrollment DWN WORN MSWD Assessment Tool 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 his PhilHealth is utilize Signature of the father Certificate of no marriage Affidavit of two disinterested persons for wrong spelling For IP patients, additional requirements from National Council for Indigenous People (NCIP) to validate the information if 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”) BN Confinement — statement of account (SOA) 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) WN Photocopy of a valid government issued ID or other legitimate proof of identity 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) wn Lh Medical Certificate and/or Medical Abstract Certificate of Indigency Drug or Medicine Prescription or Treatment Protocol, as applicable Laboratory or Diagnostic Request Hospital Bill Requirement for Social Care MSWD Assessment tool V Ue