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RENEWAL OF HOSPITAL BASED PHARMACY FOR LEVEL 1 HOSPITAL and INFIRMARY

1. Visit www.fda.gov.ph "visit old website"
2. Go to Industry corner and click downloadable
3. Go to Integrated Application Forms and Process
4. Go to "Integrated Application Form (97-2003 Compatible XLS) or "Intergrated Application Form XLSX Format
5. Fill up the form accordingly print the filled up form and have it notarized
6. Proceed to FDAC Starmall Alabang and submit notarized integrated application with signature and picture of Medical Director and Chief Pharmacist. Document Tracking Number will be issued and payment amounting of P3,030 at the FDAC cashier
7. Proceed to CHD IV-A and submit photocopy of Official Receipt during application for hospital license

Birthing Home, Infirmary, Hospital

     Checklist for Review of Floor Plan
          Birthing Home
          Infirmary
          Level 1
          Level 2
          Level 3

     Application Forms
          Application for Certificate of Need – CON for General Hospitals
          Evaluation Tool – CON for General Hospitals
          Evaluation Tool – CON for concurrent application
          Guidelines for the Planning and Design of a Hospital and Other Health Facilities
          Application for Permit to Construct
          Application Form 1– (for new and renewal License to Operate(LTO)/Certificate of Accreditation (COA) and Authority to Operate (ATO))
          Application Form 2– (for change/s in existing Health Facility)
          List of Personnel/Equipment (Annex A-B)
          List of Equipment, Reagent, Laboratory Ware and Materials for Specific Test (Annex C)
          List of Products (Annex D)
          List of Diagnostic Radiology and Radiation Oncology Services by Category (Annex E)
          List of Personnel for Diagnostic Radiology and Radiation Services (Annex F)
          List of X-ray Machines (Annex G)
          List of Equipment, Laboratory Ware and Materials (Annex H)
          List of Testing Materials (Annex I)
          List of Parameters for each Service Capability (Annex J)
          List of Equipment, Reagent, Laboratory Ware and Materials for Specific Test (Annex K)
          Health Facility Geographic Form (included in the submission of the application form)

For Additional Attachment for the Application of Licence to Operate:

The following Assessment Tools are to be accomplished and submitted depending on the facility being applied:

     Assesment Tools
          Birthing Home
          Infirmary
          Level 1
          Level 2
          Level 3

Ambulance and Ambulance Service Provider

     Application Form
          Application for License to Operate an Ambulance
          Registration of Patient Transport Vehicle

     Assessment Tool
          Ambulance

Blood Service Facility

     Application Forms
          Application for Authority to Operate a Blood Collection Unit/Blood Station (Free Standing)
          HFS Change Request Form
          Health Facility Geographic Form (include in the submission of initial application)

     Assessment Tools
          Blood Bank
          Blood Center
          Blood Collecting Unit
          Blood Station

General Clinical Laboratory

     Application Forms
          Application for License to Operate a General Clinical Laboratory
          HFS Change Request Form
          Health Facility Geographic Form (include in the submission of initial application)

     Assessment Tools
          General Clinical Laboratory
          Annex A – Service Capability of General Clinical Laboratory

Dental Laboratory

     Application Forms
          Application for License to Operate a Dental Laboratory
          HFS Change Request Form

     Assessment Tools
          Dental Laboratory

Dialysis Clinic

     Checklist for Review of Floor Plan
          Dialysis Clinic
          Reference Plan of Dialysis Clinic (14 station)

     Application Forms
          Application for Permit to Construct
          Application for License to Operate a Dialysis Clinic
          HFS Change Request Form

     Assessment Tool
          Dialysis Clinic

Drug Testing Laboratory

     Checklist for Review of Floor Plan
          Drug Testing Laboratory

     Application Forms
          Application for Permit to Construct
          Application for Certificate of Accreditation of Drug Testing Laboratory
          HFS Change Request Form
          Health Facility Geographic Form (include in the submission of initial application)

     Assessment Tool
          Accreditation of Drug Testing Laboratory

HIV Testing Laboratory

          Application Form for License to Operate an HIV Testing Laboratory
          HFS Change Request Form
          Health Facility Geographic Form (include in the submission of initial application)

Laboratory for Drinking Water

     Application Forms
          Application for Accreditation of Laboratory for Drinking Water Analysis
          HFS Change Request Form
          Health Facility Geographic Form (include in the submission of initial application)

     Assessment Tool
          Accreditation of Laboratory for Drinking Water Analysis
          Annex A & B

Psychiatric Care Facility

     Application Forms
          Application for License to Operate a Psychiatric Facility
          HFS Change Request Form

     Assessment Tool
          Acute Chronic Psychiatric Care Facility
          Custodial Psychiatric Care Facility