ANTIQUE MEDICAL CENTER

San Angel, San Jose, 5700 Antique

Telephone: 036 540 8766

June 13, 2019

MARLYN W. CONVOCAR, MD, MPH, CESO III

Director IV
DOH-CHDWV

Attention: RALPH JUSTIN CABRAL, RN, MPA

OIC Licensing Officer III, Health
Program Accreditation Cluster

Dear Director Convocar,

Greetings of Peace!

This is to signify our intent to be evaluated for Certification of our Hospital TB DOTS as a DOH PhilCAT
Certified providing hospital facility. Attached herewith is the copy of our filled up Self- Assessment Form.

Thank you very much and may God bless you!

Very truly yours,

SR. ELVIRA THEODORE IBARDOLASA, SPC

Hospital Administrator
Antique Medical Center

Curare et sanare – to care and to heal