Standard Operating Procedures

HC Medical and Surgical Clinics

Definition of Services
The HC Medical and Surgical Clinics (MSC) was set up to cater to virtually every
conceivable medical or surgical condition for walk-in patients or those who were
referred to the clinic. Patients coming into the clinic for medical or surgical
consultation will first be attended to by an accredited and experienced Internist
who will act as the Triage officer and will herein be referred to as the MSC
physician. An almost complete roster of medical and surgical specialists shall be
an integral part of the medical staff who would be made available to service the
patients either daily (Gastroenterology, Dermatology, OB-Gynecology, ENT,
Ophthalmology) or on an appointment basis (Cardiology, Pulmonology,
Nephrology, Endocrinology, Neurology, Infectious disease, Rheumatology,
Pediatrics, Plastic/Cosmetic Surgery, General Surgery, Orthopedic Surgery,
Urology) with the intention of providing for an efficient, convenient and
appropriate medical and surgical management of all patients serviced by the
clinic.

Operating Hours
The MSC shall be open to service walk-in and referred patients 9 AM to 6 PM
Monday to Saturday and shall be closed during Sundays, Regular Holidays and
Special Non-working Holidays.

Personnel - Nurses
The MSC shall be initially manned by at least two nurses going on 8 hour shifts
from 9 AM to 6 PM which will include lunch and snack breaks 5 days a week.
Additional nurses shall be employed and made available to go on duty following
the ratio of one plus one nurse per 30 clinic patients per day.
Example: Per day;
30 or less patients – two nurses
31 to 60 patients – three nurses

A MSC Head Nurse shall be employed at a later time to be decided by the Medical
Director. The MSC Head Nurse when employed shall be responsible for all the
administrative tasks of the MSC.

Personnel – Medical Staff

The MSC shall be initially manned by at least one MSC physician going on 8 hour
duty shifts from 9 AM to 6 PM which will include lunch and snack breaks Monday
to Saturday. Additional physicians shall be employed and made available to go on
duty following the ratio of one physician per 20 patients with final disposition per
day. Patients with final disposition will exclude patients sent directly to a
specialist with gynecologic, otologic or ophthalmologic complaints and those
referred to a specialist at the time of consultation but will include those patients
transferred to the UCC for hydration or intravenous drug administration.

Example: Per day;

20 or less patients – one physician
21 to 40 patients – two physicians

A MSC Section Head shall be employed at a later time to be decided by the

Medical Director. The MSC Section head shall go on 8 hour duty shifts from 9 AM
to 6 PM which will include lunch and snack breaks 5 days a week. The MSC
Section Head shall supervise and review the management of the patients by the
MSC physicians. He shall also determine and approve the specific needs of the
MSC in terms of the medical equipment and clinic supplies. In the interim while
the MSC Section Head has not yet been employed, the functions of the same shall
be performed by the Quality Assurance Director.
Personnel – Support Staff
The MSC nurses and MSC physicians shall be supported by at least one Mandarin-
speaking MSC Interpreter going on 8 hour shifts from 9 AM to 6 PM which will
include lunch and snack breaks 5 days a week. Additional interpreters shall be
employed and made available to go on duty following the ratio of one interpreter
per 30 Chinese-speaking patients per day.

Example: Per day;

30 or less Chinese-speaking patients – one interpreter
31 to 60 Chinese-speaking patients – two interpreters

The two Mandarin-speaking receptionists stationed at the Reception Desk may

also be tapped to interpret for the Chinese-speaking patients during busy hours.

Medical Equipment and Accessories

The MSC shall be equipped with 12 Lead electrocardiograms and specific
equipment for use by certain specialists; Transvaginal ultrasound by the OB-
Gynecologists, Flexible laryngoscope by the Oto-rhino-laryngologists, Slit lamp
and Digital refractor by the Ophthalmologists, Hyfrecator by the Dermatologists
and other equipment to be determined at a later time. Some of these equipment
are located in the Wellness clinic (WC) but can easily be accessed.

Duty Stations
All the MSC nurses on duty should be at the MSC nurse’s station or attending to a
patient except during lunch and snack breaks. The MSC physicians should also be
in their clinic rooms or attending to a patient at the UCC except during lunch and
snack breaks. The specialists and sub-specialists may opt stay at the Doctor’s
lounge when not attending to patients in their clinic rooms.
Process Flow
All patients seeking consult at the MSC shall first be seen by the MSC nurse who
shall obtain the necessary personal information, note down the chief complaint
and obtain the vital signs while the patient is seated at the nurse’s counter. A
patient number will be assigned to the patient and a charge slip prepared where
all the subsequent charges will be entered. The MSC nurse on duty shall then
encode all the relevant patient information in the Electronic Medical Record
(EMR) but only for patients for consultations. All walk-in patients for consultation
shall be attended to and managed by the MSC physician, except in the following
circumstances where the patients will be sent directly to the specific physician,
specialist, service center or pharmacy;
A) Patients with Ophthalmologic (eye), Otologic (ear) and Gynecologic (female
reproductive) complaints
B) Patients with appointments with specific specialists or those who would
want to consult specific physicians
C) Pediatric patients (less than 18 years of age)
D) Patients with significant lacerations or burns who shall be sent directly to
the General/Cosmetic surgeon
E) Patients with dental complaints who shall be sent directly to the dental
services
F) Patients with requests from outside physicians for X-ray, ultrasound, 12
Lead ECG or laboratory tests
G) Patients with prescriptions from outside physicians for medicines or clinic
supplies to be filled at the pharmacy

The MSC physician shall obtain a detailed history and do relevant physical
examination. Male physicians shall only conduct physical examination of a female
patient accompanied by a female nurse, female physician or companion when the
female patient has to remove part or all of her clothing. A queueing system will in
place which shall be used by the MSC nurses to direct patients to the specific
clinic room where they will be attended to. Attached are separate sheets detailing
the Flow Chart (Figure 1) and Triage Process Flow (Figure 2).

After initial evaluation by the MSC physician, patients may be referred to a

specialist or sub-specialist when the same are available in the clinic on the same
day, otherwise the patient will be managed and be given the current final
disposition by the MSC physician. Patients with urgent complaints may be
transferred to the UCC for hydration, intravenous drug administration or close
monitoring of his/her vital signs.

Only oral and parenteral medications available in the HC Pharmacy can be

administered to the patients being managed in the MSC including vaccines and
parenteral supplements. Drugs and vaccines brought in from the outside shall not
be administered in the MSC unless specifically allowed by the Medical Director.
Pediatricians are exempted from this rule and can administer vaccines which they
have brought into the clinic and kept at the pharmacy refrigerator. A surcharge of
10% of the price of the vaccine used shall be added and be credited to the clinic.

Take-home medications and clinic supplies shall be sourced as much as possible

from the HC Pharmacy. Therefore, MSC physicians, specialists and sub-specialists
should have a list of the brand names of the medicines available at the pharmacy.
When giving take-home medications, detailed written and verbal instructions
should be given by the MSC physician to be reiterated by the
pharmacist/pharmacy assistant when the prescription is filled. MSC physicians,
specialists and sub-specialists may choose to write a prescription for medicines to
be purchased outside of the clinic only if the specific medicine brand is not
available in the current medicine inventory of the HC Pharmacy.

Dental Services
Patients with dental complaints shall be directed to go straight to the area of the
dental services and be attended to by the dental technician (who shall initially act
as the dental clerk). The dental technician shall go on duty in 8 hour shifts from 9
AM to 6 PM which will include lunch and snack breaks Monday to Saturday.
Initially, the extra working day per week can either be filled as overtime or be
taken over by a reliever. A dental clerk shall be employed and made available to
go on duty when the number of patients seeking dental consultations exceed 5
patients a day.

The dental services shall be initially manned by at least one In-house dentist going
on 8 hour duty shifts from 9 AM to 6 PM which will include lunch and snack
breaks Monday to Saturday. Aside from the hourly salary, the In-house dentists
shall also receive additional pay equivalent to 10% of the basic dentistry
procedure charges. Additional dentists shall be employed and made available to
go on duty following the ratio of one dentist per 12 basic dentistry procedures per
day.

Example: Per day;

12 or less basic dentistry procedure – one dentist
13 to 24 basic dentistry procedure – two dentists

A Dentistry Section Head shall be employed to go on 4 hour duty shifts 2 days a

week. The Dentistry Section Head shall supervise and review the management of
the patients by the In-house dentists. He shall also determine and approve the
specific needs of the Dentistry Section in terms of the dental equipment and clinic
supplies. Aside from the monthly salary, the Dentistry Section Head shall also
receive additional pay equivalent to 10% of the basic dentistry procedure charges
that he has performed. Special dental procedures can be referred to the Dentistry
Section Head or other dental specialists accredited by the MSC. The charges for
these special dental procedures will have 3 components namely; 1. outsource
charge (if any), 2. procedure fee and 3. professional fee. The professional fee will
be credited to the dental specialist who performed the procedure while the
procedure fee will be credited to MSC. A list of all the dental procedures that can
be performed in the clinic with their corresponding breakdowns of the fees shall
be provided in a separate sheet (Table 1)

Other Services
Patients with requests from outside physicians for X-ray, ultrasound and 12 Lead
ECG shall be directed to go straight to the HC Imaging transaction window and be
attended to by either the radiology clerk or the ultrasound clerk. Both the
radiology and ultrasound clerks shall go on duty in 8 hour shifts from 9 AM to 6
PM which will include lunch and snack breaks 5 days a week. Charges for the
procedures shall be prepared by the clerks to be brought by the patient to the
Billing Section and paid at the Cashier.

Patients with requests from outside physicians for laboratory tests shall be
directed to go straight to the HC Laboratory transaction window and be attended
to by the laboratory clerk who shall go on duty in 8 hour shifts from 9 AM to 6 PM
which will include lunch and snack breaks 5 days a week. Charges for the
laboratory tests shall be prepared by the laboratory clerk to be brought by the
patient to the Billing Section and paid at the Cashier.

Patients with prescriptions from outside physicians who are not seeking any
medical or surgical consultations shall be directed to go straight to the HC
Pharmacy where the prescriptions shall be filled. The pharmacy shall be manned
initially by at two pharmacists/pharmacy assistants going on 8 hour shifts from 9
AM to 6 PM 5 which will include lunch and snack breaks 5 days a week. Additional
pharmacists/pharmacy assistants shall be employed and made available to go on
duty following the ratio of one plus one pharmacist/pharmacy assistant per 30
clients per day.

Example: Per day;

30 or less clients – two pharmacy/pharmacy assistant
31 to 60 clients – three pharmacists/pharmacy assistants

A Pharmacy Head shall be employed at a later time to be decided by the Medical

Director. The Pharmacy Head when employed shall be responsible for all the
administrative tasks of the pharmacy including inventory checks and purchase
order requisitions. In the interim while the Pharmacy Head has not yet been
employed, the functions of the same shall be performed by the senior pharmacist
on board.

Charges and Payments

Patients seeking consult at the MSC shall be charged a basic consultation fee Php
1,500 when attended to and managed by the MSC physician. Since the MSC
physician receives a salary for every duty hour, all of the Php 1,500 clinic fee will
be credited to the MSC. If referral is made to a specialist or sub-specialist before
final disposition of the patients, the basic consultation fee will be waived and
instead will be charged the specialist consultation fee of Php 1,800. The specialist
consultation fee shall have 2 components namely the clinic fee of Php 600 which
will be credited to the MSC and the professional fee of Php 1,200 which will be
credited to the specialist or sub-specialist.
When procedures are done (e.g. transvaginal ultrasound, flexible laryngoscopy,
slit-lamp and/or digital refraction, skin biopsy, cautery, etc.), the fee that is
charged will have 2 components namely the procedure fee which will be credited
to the MSC and the professional fee which will be credited to the specialist or
sub-specialist. A list of all the procedures that can be performed in the MSC with
their corresponding breakdowns of the fees shall be provided in a separate sheet
(Table 1).

The MSC nurse on duty shall prepare the charge slips for the clinic fees, procedure
fees, laboratory tests and imaging. The charges for the medicines administered at
the MSC will also be entered in the charge slips prepared previously. Total
charges shall be confirmed by the Billing Section for recording and all cash, credit
card and other such payment modalities shall be collected by the Cashier. No
payments cash or otherwise shall be collected by any clinic personnel including
the physicians except by the Cashier. Prescriptions for the take home medications
shall be filled in the pharmacy and shall be paid separately at the Cashier.

Electronic Medical Record and Data Privacy

For proper management of patients on subsequent consultations, personal and
clinical data of all patients seen at the MSC should be recorded and documented
in the EMR. Obtaining and recording of personal data shall be the responsibility of
the MSC nurse on duty while the MSC physician, Specialist and Sub-specialist shall
record the relevant history and physical examination findings, diagnosis,
medications administered and take-home medications given. The MSC physicians
can fill up all necessary clinical data when he/she is not attending to any patient
but should be fully accomplished before leaving the clinic at the end of his/her
duty schedule.

Only the nurses and physicians directly involved in the management of patients
will be given access to the personal and clinical data of patients seen at the clinic.
Third parties who would request for the release of such data must first seek
approval from the Medical Director. Medical certificates requested by patients
can only be accomplished by the physician who had seen and managed them.
Professional Conduct
All MSC nurses, physicians and other clinic personnel going on duty at the MSC
should behave professionally at all times even during times of adversity. The clinic
personnel should exhibit great patience and compassion especially when dealing
with difficult patients or patient’s companions. No clinic personnel including the
MSC physicians are allowed to go on duty if they have consumed even minimal
amounts of alcohol. No clinic personnel are allowed to shout back or show any
violent action or reaction to patients or their companion/s even during heated
arguments. During times when patients or patient’s companion/s exhibit
disorderly or disruptive conduct, the security guard on duty should be called to
either pacify the patient or patient’s companion/s or to escort them outside the
clinic’s premises when necessary.

Uniforms/Dress Code
All MSC nurses should wear the prescribed uniform with the HC patch worn at all
times while on duty. They should always be neat and clean with well-kept and
properly combed hair. The prescribed name tags clearly showing their names
should also be worn always while on duty.

All MSC physicians should have a white clinic gown with them while on duty to be
worn at appropriate times (it may be removed when doing procedures). The
white clinic gown should have the HC patch displayed clearly above which should
have their respective names. The MSC physicians should always wear the
appropriate clothing beneath the white clinic gown and must avoid wearing
untidy, worn-out or revealing attire.

No Smoking Policy
Patients and clinic personnel shall be forbidden to smoke (including e-cigarettes
and vapes) while inside the MSC except in the designated smoking area located
inside the Doctor’s lounge.
Dining
Clinic personnel with duty schedules from 9 AM to 6 PM are allowed to have 2
snack breaks of 15 minutes each and a 30 minute lunch break. To prevent
infestation by cockroaches and other vermin, dining by clinic personnel and
physicians shall only be permitted in the pantry and Doctor’s lounge. Dining in the
clinic rooms shall not be allowed though drinking beverages and coffee will be
allowed. Patients are allowed to dine in designated areas of the MSC.