Memorandum of Agreement - Clinician
Memorandum of Agreement - Clinician
Memorandum of Agreement - Clinician
-And-
DR. SERVILLANO M. QUIACHON, a medical clinician duly licensed by the laws of the Republic of
the Philippines, married, and a resident of Davao City, Philippines and herein referred to as the
“CLINICIAN”;
WITNESSETH:
WHEREAS, the CLINICIAN will be responsible for securing a laboratory request on all patients.
WHEREAS, the CLINICIAN l will hold responsible for interpreting the laboratory results and make
the proper diagnosis and/or management of patients.
WHEREAS, the CLINICIAN will be asked to give an initial assessment of patients of the Rugene N.
Berato Well Laboratory Diagnostic Center whose results show any significant finding and may decide to
manage the patient or suggest referral of the patient to a hospital.
WHEREAS, the DIAGNOSTIC CENTER and its personnel are not allowed to secure any laboratory
request on any patient.
WHEREAS, the DIAGNOSTIC CENTER and its personnel, are not allowed to give any initial or
final, verbal or written, interpretation of laboratory result/s to the patient.
NOW, THEREFORE, for and in consideration of the foregoing premises and of the terms,
conditions and stipulations hereunder set forth, the parties hereto have agreed, and do hereby agree as
follow:
1.1. Perform laboratory tests only if the patient provides a valid request made and signed by the
clinician.
referring them to a laboratory that can provide the service/s they need.
1.5. Conform to any patient and/or sample preparation instructed by the physician.
1.6. Not accept out-patients at night, unless they present a valid request made and signed by a
physician.
1.7. Instruct patients with no laboratory request to first see the clinician for initial assessment.
1.8. Instruct the patients to seek medical and diagnostic attention at the referral diagnostic center if the
1.1. Provide a laboratory request for all out-patients seeking laboratory services.
1.2. Inform the diagnostic center of any special endorsements on any preferences in patient and/or
sample preparation.
1.3. Inform the diagnostic center if he will not be able to do clinic hours on any specific dates.
1.4. Provide initial assessment on patients of the Rugene N. Berato Well Laboratory Diagnostic Center
COMMON PROVISIONS
The hereinafter parties agreed that their agreed responsibilities 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 that the patient is under his/her care. The determination of the liabilities of both
PARTIES in the care of the patients shall depend upon the specific factual circumstance of the case.
IN WITNESS WHEREOF, the parties hereto have signed and executed this instrument at
_______________________________ _______________________________
ACKNOWLEDGEMENT
BEFORE ME, a Notary Public for and in the City of Davao, Philippines, this ____ day of ________, 2019, at
Davao City, personally appeared:
known to me and to me known to be the same persons who executed the foregoing instrument consisting
of three (3) pages including this page where the acknowledgement is written and they acknowledged to me
that the same is their own free and voluntary act and deed.