Republic of the Philippines

Province of Ilocos Sur

ILOCOS SUR PROVINCIAL HOSPITAL –
GABRIELA SILANG DATE DEPARTMENT SIGNATURE
District City of Vigan

10/26/21 MEDICAL

OPD CARD
Foronda, Eduardo
MIS-004-0
 Age:______ Sex:______________
Maas-asin, Magsingal, Ilocos Sur
Address:_______________________________________________
___________________________

“Kadarato umay kayo agpa check up ket itugot yo daytoy a card.

“Annadan tayo daytoy a card ti makapukaw ket agmulta ti P100 pesos

ISPH- GABRIELA SILANG

OPD
Republic of the Philippines
Province of Ilocos Sur
Ilocos Sur Provincial Hospital For scheduling appointments,
Gabriela Silang
Tamag, Vigan City
please call
Out Patient Card (0975) 977 3996
At 8:00 am-4:00 pm only
MIS-004-0
Case No.:_________________
FORONDA
Last Name:________________________________
EDUARDO
First Name:________________________________
FACUNDO
Middle Name:______________________________ OB-GYNE
Married
Civil Status:______________________________
October 23, 1967
Birthday:_________________________________
DEPT. HOTLINE NO:
54 y/o male
(FOR COVID-19 PANDEMIC
PURPOSES ONLY)
09562642878