Republic 

of the Philippines )
Province of Cavite ) S.S.
Trece Martires City ) 
AFFIDAVIT OF EXPLANATION 

I, SUSAN F. NOVEJAS, of legal age, Filipino citizen, widow, with clinic address at 111 J.
De Leon Street, Brgy. 3, Ternate, Cavite, Philippines, having been duly sworn in accordance with
law, hereby depose and state:

1. That I am the registered owner of a GLADYS LYING IN CLINIC located at 111 J. De Leon
Street, Brgy. 3, Ternate, Cavite;

2. That GLADYS LYING IN CLINIC is a credited lying-in pf Philippine Health Insurance

Corporation (PhilHealth for brevity);

3. That JOY MENDOZA was one of our patients and also a member of PhilHealth with
PhilHealt Number P082017221104;

4. That JOY MENDOZA was admitted in our clinic on October 16, 2019 up to October 17,
2019 due to the delivery for her second baby;

5. That we do the early filing for her Philhealth for the said confinement;

6. That one of my staff/midwife under the person PRESILA F. SALCEDO is the one who
transact, process and file the above said transaction before the office of Philhealth-
Trece Martires City, Cavite, Philippines;

7. That I was surprised the Philheath of JOY MENDOZA was denied for the reason of
Double Filing/Same Day Filing, and Case Not Compensable;

8. That on the Double Filing/Same Day Filing due to Network error, PRESILA F. SALCEDO
was made a double entry of the filing due to her lack of knowledge on the use of Online
Encoding;

9. That on the Case Not Compensable we file the said transaction beyond sixty days (60);
days;

10. As such, I am executing this Affidavit attest to the truth of the foregoing, and for
whatever legal purpose it may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of April 2021 at Trece
Martires City, Cavite, Philippines.

SUSAN F. NOVEJAS
Affiant

SUBSCRIBED AND SWORN to before me in the Trece Martires City, Cavite, Philippines,
th
this 15 day of April 2021, who has satisfactorily proven to me her identity through her PRC
Identification bearing the number 0044253, that she is the same person who is personally
signed before me the foregoing Affidavit of Explanation and acknowledged that she executed
the same.

Doc. No. : ______

Page No. : ______
Book No. : ______
Series of : ______

Glady’s Lying-In Clinic

Maternal and Infant Care Clinic
111 J. De Leon St. Poblacion III, Ternate, Cavite
CONTACT NO. (046) 512-1451
TIN NO. 140-894-298-000

15 April 2021

ARLAN M. GRANALI
RVP, PRO IV-A
Lucena City

In Re: Explanation Letter

Sir:

I made this communication for the reconsideration of PhilHealth of one of my patients with the
following details to wit:

Name of Patient : JOY MENDOZA

Name of Member : JOY MENDOZA
Member No/PIN : P082017221104
Confinement Period : October 16, 2019 up to October 17, 2019
Claim No. : 2002110802493

That on March 23, 2021 I receive a Letter of denying of PhilHealth of JOY MENDOZA due to the
reason of DOUBLE FILING/SAME DAY CONFINEMENT and CASE NOT COMPENSABLE;

On the Double Filing/Same Day Filing due to Network error, PRESILA F. SALCEDO was made a
double entry of the filing due to her lack of knowledge on the use of Online Encoding;

On the Case Not Compensable we file the said transaction beyond sixty days (60) days.

And we also comply all the requirements needed for the said transaction/claim.

That you for your very kind consideration.

Thank you,

SUSAN F. NOVEJAS
Owner-Gladys Lying-In Clinic