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  • Opd Approval

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    HMO isshi
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    This document is an OPD approval form from Isabela South Specialists Hospital. It contains fields for the hospital contact number, type of availment whether outpatient, outpatient/operating room/emergency room, member ID number, full name, company, diagnosis, procedure, price, history/chief complaint, requesting doctor, name of staff filling out the form and their department, and a call back number.

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    OPD APPROVAL

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    This document is an OPD approval form from Isabela South Specialists Hospital. It contains fields for the hospital contact number, type of availment whether outpatient, outpatient/operating room/emergency room, member ID number, full name, company, diagnosis, procedure, price, history/chief complaint, requesting doctor, name of staff filling out the form and their department, and a call back number.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    11 views2 pages

    Opd Approval

    Uploaded by

    HMO isshi
    This document is an OPD approval form from Isabela South Specialists Hospital. It contains fields for the hospital contact number, type of availment whether outpatient, outpatient/operating room/emergency room, member ID number, full name, company, diagnosis, procedure, price, history/chief complaint, requesting doctor, name of staff filling out the form and their department, and a call back number.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    OPD APPROVAL FORM

    HOSPITAL ISABELA SOUTH SPECIALISTS HOSPITAL

    CONTACT NUMBER OF HOSPITAL

    TYPE OF AVAILMENT(OP;OP/OR/ER)

    MEMBER'S ID NUMBER

    FULL NAME:

    COMPANY:

    DIAGNOSIS:

    PROCEDURE:

    PRICE:

    HISTORY/ CC:

    REQUESTING DOCTOR:

    NAME OF STAFF: MARILOU P. BALANTAC

    DEPARTMENT: HMO STAFF

    CALL BACK NUMBER:


    RM
    LISTS HOSPITAL

    LANTAC

    FF

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