Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Citystate Centre Building, 709 Shaw Boulevard, Pasig City
Healthline: 441-7444 Website: www.philhealth.gov.ph

Date & Time of Generation : OCTOBER 26, 2019 11:43:01 AM

HCI Portal Reference No. : BEF100000038674994
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HEALTH CARE INSTITUTION (HCI) INFORMATION
Name of Institution : DR. PETRONILO V. SEARES SR. MEMORIAL HOSPITAL
Accreditation No. : H13000102
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MEMBER INFORMATION
PhilHealth Identification No. : 041751552635
Name of Member : LABANEN SR, LINO SIBAYAN
Sex : MALE
Date of Birth : JANUARY 10, 1942
Member Category : LIFETIME MEMBER - RETIREE/PENSIONER - GOVERNMENT
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PATIENT INFORMATION
Name of Patient : LABANEN SR, LINO SIBAYAN
Date Admitted : OCTOBER 23, 2019
Sex : MALE
Date of Birth : JANUARY 10, 1942
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ELIGIBILITY INFORMATION
ELIGIBLE TO AVAIL PHILHEALTH BENEFITS? = YES

Reason/s:
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Attached Documents:
N/A
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Important Reminders:
1. Generation and printing of this form is FREE for all PhilHealth Beneficiaries.
2. This form shall be submitted along with the required PhilHealth claims forms and is valid only for the confinement/admission stated above.
3. This does not include eligibility to the rule of SINGLE PERIOD OF CONFINEMENT(SPC). It shall be established when the claim is processed by PhilHealth.
Non-qualification to the rule on SPCshall result to denial of this claim.
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