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REPUBLIKA NG PILIPINAS

(Republic of the Philippines)
TANGGAPAN NG PANGULO
(Office of the President)
TANGGAPAN NG SWEEPSTAKES PANGKAWANGGAWA NG PILIPINAS
(PHILIPPINE CHARITY SWEEPSTAKES OFFICE)
CHARITY ASSISTANCE DEPARTMENT
CITIZEN’S CHARTER

Schedule of Availability of Service:
Monday – Friday
6:00 a.m. – 5:00 p.m.

Who May Avail of the Service: (per Board Resolution 272)
Individuals with health and physical problems shall avail of the Individual Medical Assistance Program (IMAP) provided that she/he meets the following criteria:

Poverty Threshold of P19,345.00 (urban) and P16,508.00 (rural) per person per year for food and non-food items (as per National Statistics Coordination Board)

Patients confined in the Charity Ward are given priority.

Patients who are confined in the Pay Ward by reasons beyond their control such as:

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Emergency cases

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Non-availability of Charity Ward

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Communicable diseases which need isolation

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Intensive Care Unit cases

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Maternity with complications

Out-patients who are in need of chemo, post operative medication, OR needs, antibiotics, laboratory and diagnostics procedures or those patients whose illness does not need confinement.

signature and license # of the attending physician • Official Price Quotation from the pharmacy (c/o PCSO) • Original/Certified True Copy of histopath/biopsy report duly signed by pathologist with printed name and license number • Relevant laboratory test result (for medicines) • Valid ID (patient and representative) REQUEST FOR LABORATORY/DIAGNOSTIC PROCEDURES • Personal Letter Request addressed to Chairman/General Manager of PCSO • Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number . HMOs.What are the Requirements: REQUEST FOR HOSPITALIZATION • Personal Letter Request addressed to Chairman/General Manager of PCSO • Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number • Statement of account/hospital bill certified by the billing officer/credit supervisor with printed name and signature (All necessary deduction. such as Philhealth. Must be reflected in the bill) • Endorsement letter from the hospital social service for service patients (for charity) • Promissory Note (if discharged) • Valid ID (patient and representative) REQUEST FOR MEDICINES AND CHEMO • Personal Letter Request addressed to Chairman/General Manager of PCSO • Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number • Prescription with printed name. if applicable. Senior Citizen.

• Order Form from the doctor duly signed with license number stating need for laboratory/procedure • Official Costing of the said procedure from the laboratory section department of the hospital • Valid ID (patient and representative) REQUEST FOR IMPLANT / PROSTHESIS / WHEELCHAIR • Personal Letter Request addressed to Chairman/General Manager of PCSO • Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number • Three (3) Official Price Quotation from different suppliers • One (1) whole body picture for wheelchair request • Prescription / Specifications of the implant needed • Proof of counterpart from the patient/client • Photocopy of x-ray or ct scan report for implants • Valid ID (patient and representative) REQUEST FOR DIALYSIS/PERITONEAL DIALYSIS • Personal Letter Request addressed to Chairman/General Manager of PCSO • Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license • Endorsement/Certificate of Acceptance of PCSO guarantee letter from the hospital or dialysis center • Official Price Quotation (for hemodialysis) • Prescription of Dialysis Solutions (for peritoneal dialysis) • Valid ID (patient and representative) REQUEST FOR HEARING AID • Personal Letter Request addressed to Chairman/General Manager of PCSO • Clinical Abstract with name. signature and license number of doctor • Audiological Evaluation signed by the Audiometrist independent from the Audiometric Center .

000 Five (4) days Cases above P200.000.00 Seven (6) days • Filing of Application for peritoneal dialysis / hemodialysis / post operative – every 2 months from the date of the last released of Guarantee Letter (GL) .• Three (3) Official sealed Price Quotations from the different hearing aid centers / cochlear implant supplier • Proof of counterpart from the patient/client • Valid ID (patient and representative) REQUEST FOR OPERATION • Personal Letter Request addressed to Chairman/General Manager of PCSO • Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number and PTR number • Official Price Quotation • Valid ID (patient and representative) DURATION: Hospitalization for discharge and cases needing urgent treatment For P100.00 and below – four days from the date of interview Cases above P200.000.00 and below – within the day Regular cases For P100.000.

For cases with incomplete document and without appointment Endorsement letter Referral Letter . chemotherapy. .Provides checklist/ orients client with needed requirement.How to Avail of the Service: Step Service Provider Applicant/ Client Duration of Activity (Under Normal Circumstances) Person-in-Charge Fees (Services are rendered free of charge) Forms Needed Not Applicable Prescribed documentary requirements STAGE 1: Evaluation of Application (Day 1) 1 Submit all documentary requirements. Note: Priority lane for Senior Citizen and Person With Disability (PWD) Requirements checklist A2.Endorses cases for medical evaluation (for request of medicines. A. 5 minutes per case .Attaches application forms for those with complete documents. For cases with complete documents (With appointment and New cases) Officer-of-the-Day (OD) Juanito Hermancio Mariquita Reyes Josephine Zafra Jose Osorio 3 minutes per case IMAP Application Form . Reviews requirements under the IMAP guidelines A1.

maternity and psychiatric cases) Schedule slip . radiotherapy. 2 minutes per case Wait for the assigned SW to be flashed in our monitor/screen Volunteer Not Applicable . hearing aid and cochlear implant. diagnostic procedures.Prepares referral for price quotation (for laboratory. implants. hearing aids and other requests requiring official quotation) . implant.Schedules cases for interview 2 Fill-up the application form 3 Proceed to the waiting area and wait for your number to be called in the queuing system for interview. radiotherapy.diagnostic and laboratory procedures.

Prepares guarantee letters (GL) 7 .Reviews and affix signature in the GL 2 minutes per case Encoder 2 minutes per case (Day 2) Gina Balde (Supervisor) Elizabeth Lompot Ursula Aguilar Bernard Romero 2 minutes per case (Day 2) Division Chief III Herminia B. Reyes or her authorized Not Applicable Not Applicable Guarantee Letter .4 Interview phase – proceed to the assigned SW – Interviews. assesses and classifies request and prepares recommendation/SCSR 20 minutes per case – Reviews.Encodes transmittal of cases for approval . confirms and affixes signature in the recommendation (SCSR) Not Applicable Myla Copino Diana de Sagun Ira Salayon Ethel Lovino Beryl Salvadora Remelyn Cuaresma Lydia Criscel San Juan Christine Casillano Rosa Lee Mamaradlo Mary Ann Cunanan Amor Tanguilig Eden Razon Enrique Cristobal – Issues claim slip and advise client to comeback on the specified date for the release of guarantee letter. 5 Social Workers (SW) 3 minutes per case Supervisor IMAP Assessment Form Claim Slip to be given by the assigned SW upon completion of interview Feedback Form to be filled up by client after interview Not Applicable Marivic Llanes Maricar Santos Leslee Deabanico Lilibeth Javier STAGE 2: PROCESSING OF GUARANTEE LETTERS (DAY 2-6) 6 .

00 2 minutes per case (Day 6) General Manager/Chairperson Not Applicable . Jose Bernardo H.000.Approves cases not more than P100.Recommends cases more than P100.000.Receives and data bank approved IMAP cases 2 minutes per case (Day 4 for cases P200.000.000.00 2 minutes per case (Day 3) OIC-Department Manager Dr.00 upon approval of authorized signatory Note: The processing time is for one client being served at one time. The time is extended when there are more clients.Approves cases not more than P200.representative 8 .00 9 10 11 . . Gochoco or his authorized representative Not Applicable . General Manger Not Applicable .00 and below) Releasing Section Not Applicable Aida Tizon (Supervisor) (Day 7 for more than P200.Approves cases more than P200.000.00 2 minutes per case (Day 4) Asst.000.

. The time is extended when there are more clients. JOSE BERNARDO H.D.If the guarantee letters are not yet available.Validates the identity of the claimant through the presented ID and records submitted during the interview.Dry-seal the approved guarantee letters Aida Tizon Nancy Filart Florida Dela Torre Allan Domingo Ronald Magada Rommel Azucena Not Applicable .Releases approved guarantee letters 3 minutes per case Not Applicable END OF TRANSACTION Note: The processing time is for one client being served at one time. Service Provider Accepts and reviews claim slip .M.Locates and retrieves approved guarantee letters. Duration of Activity (Under Normal Circumstances) Person-in-Charge Fees Forms Needed 1 minute per case Releasing Section Not Applicable Claim Slip 6 minutes per case .Manager. OIC. GOCHOCO. Receive the approved guarantee letters .Releasing of Guarantee Letters Step Applicant/Client 1 Submits claim slip 2 Wait while the guarantee letters are being retrieved/located. present valid ID . inform the client that it is not yet available. JR. 3 When the patient name is called. Charity Assistance Department .