DOH Guidelines on PEME for Overseas Filipinos

Policy, objective, and purpose

The Department of Health (DOH) regulates medical clinics that conduct pre-employment medical examinations (PEME) for Filipino migrant workers as a requirement for overseas employment.
DOH establishes guidelines to ensure access to safe, quality and affordable health facilities and PEME services for Filipino migrant workers.
The objective is to carry out Rule XI: Role of DOH in the Omnibus Rules and Regulations implementing the Migrant Workers and Overseas Filipinos Act of 1995, as amended by Republic Act No. 10022.

Coverage and application

The order applies to all DOH accredited medical clinics that conduct PEME for land based overseas work applicants and seafarers for domestic/overseas employment.
All PEME for overseas work applicants must be performed only in DOH accredited medical clinics and health facilities using DOH standards set by DOH through BHFS.

Key definitions established

Applicant refers to a person defined under # 15 of the Definition of Terms (as used for purposes of the order).
Assessment Tool means the checklist used by regulatory officers during inspection or monitoring visits to evaluate DOH accredited medical clinics’ compliance with minimum standards set through BHFS.
Audiometry is the minimum hearing screening test using air conduction.
Board Certified Physician is a physician who is a Diplomate and/or Fellow of a medical specialty and/or subspecialty society recognized by the Philippine Medical Association and certified by the corresponding medical specialty/subspecialty board.
Bureau of Health Facilities and Services (BHFS) is DOH’s regulatory agency exercising the accreditation and regulatory function under these rules.
Certificate of Accreditation (COA) is the formal authorization issued by BHFS to operate a medical facility for overseas workers and seafarers, reflecting compliance with input/structural, process, and outcome/output standards.
Department of Foreign Affairs (DFA) authenticates PEME certificates via the DFA Ribbon for applicants bound to other countries.
DOH Accredited Medical Clinic is a medical facility for overseas workers and seafarers that has complied with DOH accreditation requirements.
Department of Health (DOH)-Permit to Construct (DOH-PTC) is a permit issued through BHFS allowing an applicant to establish and operate a medical facility upon compliance with required documents prior to construction, and it is required for substantial alteration/expansion/renovation as well as a prerequisite for accreditation.
E-Commerce Law refers to Republic Act No. 8792 on the recognition and use of electronic commercial/non-commercial transactions and documents.
Fitness date is the date of issuance of a fit PEME certificate, and the ninety (90) day validity begins on the date of fitness issued by DOH accredited clinics.
Full Time means eight (8) business hours a day, five (5) days a week, Monday through Friday or during clinic business hours.
Maritime Industry Authority (MARINA) regulates/integrates the development, promotion, and regulation of the maritime industry in the Philippines.
Overseas Filipino Worker (OFW) or migrant worker is a person engaged or to be engaged in remunerated activity in a state of which the person is not a citizen, or onboard a vessel navigating foreign seas (excluding government ships used for military/non-commercial purposes), or on offshore/high seas installations; an applicant worker is one promised/assured employment overseas.
Pre-Employment Medical Examination (PEME) is the DOH standard medical examination conducted prior to deployment to determine whether the applicant is physically and mentally fit for work, for both land based applicants and seafarers.
Peer Review Committee is created by the Secretary of Health to review and decide contested PEME results.
Philippine Overseas Employment Administration (POEA) issues the Overseas Employment Certificate (OEC) serving as work travel exit clearance at airport and immigration counters.
Principal is an employer or foreign placement agency hiring/engaging Filipino workers through a licensed private recruitment/manning agency.
Quality Standard System (QSS) is documented policies/procedures/instructions aligned with quality management standards and designed to meet statutory/regulatory requirements for health facilities and services certified by a DOH recognized certifying entity.
Repatriation is the return of an OFW, dead or alive, from a job site overseas for reasons including completion of employment, labor conflicts, medical causes, psychosocial problems, wars, restrictive immigration policies, and others.
Standards for Training, Certification and Watchkeeping (STCW) is the international convention setting minimum standards for training, certification, and watchkeeping for seafarers.
Part Time refers to personnel working fewer hours than full-time employees while continuously serving to fulfill functions not requiring continuous presence (e.g., specialist physicians).

DOH regulation: general and specific rules

DOH regulates clinic operations for medical, physical, optical, dental, psychological and other similar examinations required for overseas employment.
All clinics must ensure the medical examination scope complies with DOH standards set through BHFS.
DOH regulates PEME fees by setting a minimum and maximum range of fees through thorough periodic review and stakeholder consultation, and DOH ensures fees are reasonable to cover services rendered.
No group of medical clinics may obtain a monopoly to exclusively conduct health examinations for migrant workers for certain receiving countries.
Each Filipino migrant worker must be free to choose any DOH accredited or DOH operated clinics, with patient rights respected, except where a seafarer’s medical examination cost is shouldered by the principal/shipowner.
The “de k ding practice” requiring overseas Filipino workers to register in an office and then be farmed out to another clinic is prohibited, and clinics must strictly observe Administrative Order No. 2011-0015, as amended by Administrative Order No. 2011-0015-A.
Every clinic must maintain a valid QSS certified by a DOH recognized certifying entity.
All clinics must observe the same standard operating procedures and comply with internationally accepted standards in operation.
BHFS shall coordinate with DFA to strengthen diplomatic relations and disseminate DOH regulatory policies and standards for Filipino migrant workers’ rights and health interests.
Stakeholders must comply with standards and requirements in the Assessment Tool for accreditation posted at DOH’s website (doh.gov.ph), the order and annexes, and other related policy guidelines/issuances.

PEME facility standards and systems

Clinics must be organized to provide quality, effective, and efficient PEME services for overseas work applicants.
Personnel must be adequate, qualified, trained, and competent based on workload and services provided.
All clinical, technical, and support staff must be physically present during clinic operating hours.
Clinics must have minimum full-time personnel, including:
- a Medical Director (Head of Medical Director) who is a PRC-licensed physician overseeing overall medical operations;
- Examining Physician(s) PRC-licensed;
- Registered Nurse PRC-licensed nurse assisting with medical history, vitals, cardiogram, and pre- and post-HIV test counseling;
- Psychologist(s) complying with Republic Act No. 10029 and DOH requirements;
- Psychometrician(s) complying with Republic Act No. 10029 and DOH requirements;
- Audiometrician(s) with training certification from a competent provider/authority/professional organization;
- Dentist(s) PRC-licensed.
Ancillary full-time personnel must include:
- a Pathologist heading the clinical laboratory, PRC-licensed and certified by the Specialty Board of the Philippine Society of Pathologists; when part-time, the head must visit at least once a week with documented visit;
- Medical Technologist(s) PRC-licensed, with at least one (1) medical technologist holding a valid HIV proficiency certificate;
- a Radiologist heading the imaging facility, PRC-licensed and certified by the Specialty Board of the Philippine College of Radiology; when part-time, the head must visit at least once a week with documented visit;
- X-ray technologist(s) PRC-licensed.
Administrative/support full-time personnel must include:
- an Administrative Officer (AO) responsible for overall administrative areas and clinic operations;
- a Quality Management Representative (QMR) who initiates/supports/implements quality assessment and performance improvement activities in line with clinic quality objectives.
Physical facilities must include adequate spaces ensuring staff/client safety and must conform to applicable local and national construction and facility regulations.
Each clinic must have an approved DOH-PTC in accordance with DOH planning guidelines posted at doh.gov.ph, including:
- signed and sealed floor plan by a licensed architect and/or engineer,
- the functional areas required in annexed reference plans (including separate male/female examination rooms).
Service delivery must be supported by:
- a Manual of Operations;
- documented Standard Operating Procedures (SOP) for PEME;
- documented technical policies/procedures for each PEME activity ensuring quality PEME results.
Information management must include:
- a communication/recording/reporting system to DOH;
- an electronic uploading system by DOH for submission of clinic data to BHFS in migration information format using procurement rules under Republic Act No. 9184;
- linking of computer facilities for free-flow data exchange and sharing among concerned agencies.
Clinics must ensure prompt PEME results within seventy two (72) hours from the time of examination.
Clinics must submit data required by DOH through BHFS for research, standards setting, access improvement, and related purposes.
Clinics must follow the DOH PEME Certificate templates posted at doh.gov.ph for land based workers (Annex C) and seafarers (Annex D).
Clinics must submit monthly reports to BHFS using DOH statistical report formats posted at doh.gov.ph, including:
- Annex E Statistical Report on PEME,
- Annex F Statistical Report on Selected Laboratory Test,
- Annex G Statistical Report on Psychological Assessment,
- Annex H Cases of Repatriation.
Clinics must report HIV test results using the HIV Screening Test Certificate format (Annex I) posted at doh.gov.ph.
Reports must be automated/computerized.
Clinics must maintain and register required logbooks and comply with maintenance and monitoring references (including equipment preventive/corrective maintenance and facility maintenance/monitoring).
Medical records/certificates must bear the authorized examining physician and medical director names and signatures, and electronic signatures must follow Republic Act No. 8792 rules on electronic transactions.
Confidentiality and access to applicant records must be observed, and retention and disposal of medical records (paper or electronic) must follow DOH or competent authority standards.

Basic DOH PEME package and standards

The basic DOH PEME package for overseas work applicants must follow DOH/BHFS standards and requirements (Annex K).
Seafarer medical standards must follow the current ILO/IMO Guidelines on the Medical Examinations of Seafarers (Annex L).
A migrant worker must undergo health examinations only when there is reasonable certainty, certified by the hiring recruitment/manning agency pursuant to POEA rules and regulations that the worker will be hired and deployed, and only examinations that are absolutely necessary for the job type applied for or specifically required by the foreign employer.
A foreign employer that does not honor the results of a valid health examination conducted by DOH accredited or DOH operated clinics must be temporarily disqualified from participating in the overseas employment program under POEA rules; disqualification may be lifted only upon the foreign employer’s unqualified acceptance of the examination results.
The applicant must pay directly to the DOH accredited medical clinic where PEME is conducted, except for seafarers whose medical examination cost is shouldered by the principal/shipowner.

PEME validity and required retesting

A fit to work PEME certificate is valid only for ninety (90) days (or less if required by the host country/employer) prior to deployment.
If the applicant is not deployed within ninety (90) days after the date of fitness, the applicant must undergo a complete basic DOH PEME.
A land based overseas work applicant must undergo PEME for every contract.
For a seafarer, a fit for duty PEME certificate is valid for a maximum of two (2) years, conditioned on deployment within ninety (90) days from the date of fitness.
For seafarers:
- if below 18 years old, maximum validity is one (1) year; and
- if limited due to health reasons, validity applies subject to the stated conditions.

Repatriation and contested results

When an OFW is found not medically fit within fifteen (15) days upon arrival in the destination country, the medical clinic or health facility that conducted the OFW’s health examination(s) must pay repatriation back to the Philippines and the cost of deployment.
Any DOH accredited clinic that violates provisions under Section 16 of Republic Act No. 10022 must face, in addition to other liabilities, revocation of DOH accreditation if investigation shows the medical reason for repatriation could have been detected at the time of examination using the DOH PEME package required by the principal or receiving country.
The repatriated OFW must report to BHFS within fifteen (15) days upon arrival in the Philippines and submit:
- passport (exit visa),
- boarding pass,
- medical certificate with English translation detailing cause of repatriation,
- pertinent documents in the worker’s possession.
BHFS must refer the repatriated worker to the Peer Review Committee for evaluation.
A Peer Review Committee is created by the Secretary of Health based on BHFS recommendations and appeals by applicants declared unfit.
When a PEME result is contested by an applicant, recruitment/manning agency, company, or other interested party, BHFS may be assisted by medical/allied medical experts.
Hospitals identified by DOH must create Peer Review Committee(s) in different fields of specialization using a named Annex M reference including Department Order No. 185-N s. 1996.
The Peer Review Committee must include:
- a chairperson who is a Head of Medical Surgical Department;
- medical examiner(s)/examining physicians from hospitals/clinics, including:
  - a physician from a selected government specialty center; and
  - a board certified specialist in the case area.
The Peer Review Committee’s expert opinion and recommendations must be transmitted to the Director of BHFS.
The Peer Review Committee’s decision is final.

Accreditation (COA) and permitting (DOH-PTC)

BHFS issues COAs for DOH accredited medical clinics and renews them upon full compliance with standards and requirements in the Assessment Tool.
BHFS suspends or revokes COAs of DOH accredited clinics.
COA application procedure requires:
- clinics to download the prescribed application form from doh.gov.ph,
- submission to BHFS of the accomplished form with necessary attachments,
- payment of a non-refundable application fee upon submission,
- compliance with Administrative Order No. 2008-0027 (One Stop Shop System for regulation) and related issuances and the order.
COA initial status includes:
- a one-time cash bond of PHP 100,000.00 refunded upon clearance from BHFS once the clinic terminates operations;
- a requirement to have valid QSS certification within six (6) months from COA issuance, otherwise COA is revoked.
COA renewal status includes:
- filing renewal within ninety (90) days before expiration,
- possession of valid QSS certification prior to renewal,
- automatic cancellation if the clinic fails to submit a duly accomplished application and fails to pay the proper fee on or before accreditation expiration, requiring the clinic to cease operations and apply for a new COA.
DOH-PTC application, inspection, and monitoring follow procedural guidelines under Administrative Order No. 2008-0027 and Administrative Order No. 2012-0012.

Fees, posting, and display requirements

Clinics must post examination fees at conspicuous areas.
Clinics must display the cost of the basic DOH PEME package at the reception area using at a minimum a tarpaulin of not less than two (2) feet by three (3) feet, legible from twenty (20) feet, and display other package costs in a similar manner.
Fees must comply with Administrative Order No. 2008-0028 (Schedule of Fees for the One Stop Shop System), related issuances, and this order/annexes.

COA duration, conditions, and change reporting

COA validity is three (3) years, covering January of the first year to December of the third year.
Clinics must notify BHFS in writing within fifteen (15) days of any change in:
- personnel,
- physical facility, or
- provision of other relevant services affecting COA status,
  and must attach necessary credentials and contract of service of new personnel.
COA may be revoked, suspended, or modified in whole or in part for:
- false statements by management and/or staff,
- inspection/monitoring findings,
- violation of or failure to comply with terms/conditions/provisions, annexes, or related issuances.

Enforcement: investigations, violations, and sanctions

BHFS investigates charges/complaints filed by any individual, corporation, association, or organization against a clinic or its personnel for violations of laws and/or rules regulating medical clinics and ancillary facilities/services.
Upon investigation and hearing:
- the BHFS Director imposes the corresponding sanction if violations are found; and
- government health facility personnel involved are subject to appropriate disciplinary/administrative action under Civil Service rules; and
- professionals subject to the Professional Regulation Commission are treated such that the finding of guilt is considered a formal complaint and is immediately filed with their respective Professional Regulatory Boards; judicial authorities may also be pursued for appropriate action.
BHFS may seek assistance from the Food and Drug Administration if investigation involves ancillary facilities such as pharmacy and/or x-ray facilities, and must provide a copy of the investigation report to the concerned bureaus.
Violations occur when stakeholders violate any provision of the guidelines and related issuances, including failure of an OFW clinic to honor the Peer Review Committee decision and acts/omissions by personnel operating the health facility under this order; sanctions include COA suspension or revocation.
Penalties for clinics (regardless of offense nature), excluding repatriation cases:
- First offense: PHP 50,000.00,
- Second offense: suspension of COA and/or fine of PHP 100,000.00,
- Third offense: revocation of COA.
For repatriation cases, the penalty is revocation of COA.
Preventive suspension:
- If inspection/monitoring shows violations or prohibited acts, BHFS may immediately preventively suspend clinic operations for not more than sixty (60) days.
- Preventive suspension may also be applied upon filing of a complaint for violation of Section 16 of Republic Act No. 10022.
- During preventive suspension, the clinic must cease operations and must not accept any client for medical examination.
- Any violation of preventive suspension is a ground for revocation of COA.

Appeal and finality

A clinic whose COA is denied or suspended/revoked may, after filing a Motion for Reconsideration with BHFS, elevate the case to the Office of the Secretary, which forwards it to the appropriate bureau for review and recommendation.
The reviewing offices may request further clarifications, documents, or memoranda; bureaus must submit findings/recommendations to the Office of the Secretary.
The decision of the Office of the Health Secretary is final and executory.

Transitory, repealing, separability clauses

DOH accredited medical clinics have until June 30, 2014 to attain full compliance with the rules and regulations in the order and annexes.
All administrative orders, circulars, rules, and regulations inconsistent with this order are impliedly or expressly amended or revoked.
If any provision or part of the order is declared unauthorized or invalid by a court or competent authority, the remaining provisions continue in force.

Roles and responsibilities of agencies

DOH-BHFS:
- issues and renews COAs upon compliance with the Assessment Tool standards,
- suspends or revokes COAs,
- conducts fact-finding investigations before resolution,
- refers cases involving violations to concerned government agencies for appropriate action.
DOH accredited medical clinics:
- conduct PEME upon full compliance with standards and requirements in the order and annexes,
- submit PEME reports to BHFS for appropriate action.
POEA acts on cases referred by DOH involving deficiencies and violations of recruitment/manning agencies related to required health examinations in the basic DOH PEME package and in the country of destination.
DFA and POEA act on DOH-referred cases involving foreign employers who do not honor valid health examination results issued by DOH accredited or DOH operated clinics.
Civil Service Commission acts on DOH-referred cases involving non-feasance and malfeasance of duties by DOH officials/employees under the order.
Local Government Units (LGUs) must partner with POEA and other concerned government agencies and non-government organizations to disseminate information to constituents on overseas employment aspects in the fight against illegal recruitment.

Named implementing rules and cross-references

DOH accreditation and the one-stop shop system align with Administrative Order No. 2008-0027 (One Stop Shop System for regulation with ancillary services).
Applications/inspections for facilities align with Administrative Order No. 2012-0012.
Fee posting and schedule align with Administrative Order No. 2008-0028.
Prohibition of referral/decking practices aligns with Administrative Order No. 2011-0015, as amended by Administrative Order No. 2011-0015-A.
Repatriation penalty and medical-detection standards tie to Section 16 of Republic Act No. 10022 (as referenced in the order).
Electronic signatures for records/certificates align with Republic Act No. 8792.
Authorized appeal mechanism ties to the order’s motion for reconsideration process with BHFS and final decision by the Office of the Health Secretary.