QUIJANO CLINIC & HOSPITAL, INC.

Nationa Highway, Tacurong City

Tel. No.: (064) 200 3713

AUTHORIZATION

To whom it may concern:

This is to authorize _______________________________________, my ________________ to

procure medicine as indicated in the prescription with my doctor, Dr. _____________________,
with the use of my Senior Citizen’s discount certificate from the City Government.

Thank you very much.

Yours truly,

____________________

S2 _____________________
PTR ____________________

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QUIJANO CLINIC & HOSPITAL, INC.

Nationa Highway, Tacurong City
Tel. No.: (064) 200 3713

AUTHORIZATION

To whom it may concern:

This is to authorize _______________________________________, my ________________ to

procure medicine as indicated in the prescription with my doctor, Dr. _____________________,
with the use of my Senior Citizen’s discount certificate from the City Government.

Thank you very much.

Yours truly,

____________________

S2 _____________________
PTR ____________________