ATTESTATION FORM OF CHD VALIDATORS

I, JAYA P. EBUEN, DMO IV, a duly authorized representative of DOH - MMCHD do

hereby declare and attest to the following:

1 . That the submission of A R D I H E A L T H S E R V I C E S I N C , .in NATIONAL

CAPITAL REGION had undergone thorough verification and validation by the
management of this facility as manifested in their attestation form.

2. That this submission through the Health Emergency Allowance Processing

System (HEAPS) had been validated based solely on the information made
available by the facility and guided by the provisions of Republic Act 11712
“Public Health Emergency Benefits and Allowance for Health Care Workers Act”,
its implementing rules and regulations and supplemental guidelin. Should the
actual facts be different from the information contained in the submitted CREC
report to which this CHD/FICT/MST is not in position or no capacity to verify, the
facility shall bear sole responsibility therewith.

3. That proper exercise of diligence had been observed in the validation of this
submission and in consideration of the presumption of regularity.

Done this 25th day of June, 2023 in DOH-MMCHD.

By:

JAYA P. EBUEN, RN

DMO IV