Republic of the Philippines

Department of Health
MALASAKIT PROGRAM OFFICE

October 24, 2022

CERTIFICATION

This is to certify that patient ASHREIN BATAIN TOJON, 21y/o , of SANTO TOMAS BATANGAS, was extended by this office, a total of
Php10,000.00, medical assistance stated below based on the existing guidelines of Administrative Order No. 2020 - 0060, dated December 23, 2020:

Type of Assistance Utilization Remaining Balance Date/Time

Hospital bills / Laboratory / Procedures / Medicines ( ) 0.00 10,000.00

Total Amount P 0.00 P 10,000.00

U-PGH-221024-75368564BC
GIRLIE E. VELOSO
Director IV

Notes:
50% maximum applicable for PF
Non-Convertible to cash

Encoded by: JAVC

STA CRUZ MANILA, 651-7800 Local: 1807, 1810, 1811, 1805, and 2908, doh.gov.ph

-------------------------------------------------------------------------------------------------------------------------

Republic of the Philippines

Department of Health
MALASAKIT PROGRAM OFFICE

October 24, 2022

CERTIFICATION

This is to certify that patient ASHREIN BATAIN TOJON, 21y/o , of SANTO TOMAS BATANGAS, was extended by this office, a total of
Php10,000.00, medical assistance stated below based on the existing guidelines of Administrative Order No. 2020 - 0060, dated December 23, 2020:

Type of Assistance Utilization Remaining Balance Date/Time

Hospital bills / Laboratory / Procedures / Medicines ( ) 0.00 10,000.00

Total Amount P 0.00 P 10,000.00

U-PGH-221024-75368564BC
GIRLIE E. VELOSO
Director IV

50% maximum applicable for PF Recieved by

Non-Convertible to cash ________________________
Signature over Printer Name
Date Recieved: ___________
Encoded by: JAVC

STA CRUZ MANILA, 651-7800 Local: 1807, 1810, 1811, 1805, and 2908, doh.gov.ph