September 29, 2019

THE MANAGER
HEALTHSERV LOS BAÑOS, INC.
8817 National Highway,
Los Baños, Laguna

Dear Sir/Ma’am,

I, Reniro P. Flores, do hereby authorize my sister, Roina P. Flores, to request a copy of my medical
records, medical abstract and operative records on my behalf to your good office. Attached are my 2
valid ids for your reference.

If you have any questions, please contact me at +639662736377.

Thank you.

RENIRO P. FLORES