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
