MEDICAL SERVICES DIVISION

LETTER OF ENDORSEMENT (LOE)

Date: Annual Physical Exam (APE) LOE NO. 38103300- Eastwood

X Pre-Employment Medical Exam (PEME)

TO: Hospital / Clinic Name: HI PRECISION DIAGNOSTIC

TEL. NO. (02) 721-7777 FAX NO.
LOE REQUESTED BY: DATE/TIME:

Remarks: Important reminders:

Please send results to Please present your valid PhilCare ID together with one (1) government-issued ID with
picture (if PEME, two (2) government-issued ID).
Urine collection will be done during the actual medical exam preferably collected
midstream.
Collect pea-sized stool specimen & place it in a container. This should be submitted to
the laboratory within two (2) hours after collection.

Name of Member: Age: Gender: Date of Birth: Product:

Company Name: MAJOREL PHILIPPINES CORP. Validity:

Package: BASIC 5 (Physical Examination, CBC, Urinalysis, Fecalysis, Chest x-ray), DRUG TEST (2 PANEL) , RAPID ANTIGEN
ADDITIONAL TEST REPEAT TEST CONFIRMATORY TEST
ECG PAP SMEAR FBS CBC FECALYSIS XRAY URINALYSIS RT-PCR DRUG TEST

KINDLY SEND ALL BILLING STATEMENTS TOGETHER WITH THIS LOE. CLAIM DOCUMENTS WITHOUT THIS ATTACHMENT WILL NOT BE PROCESSED. THANK YOU.

Endorsed by: Date & Time Prepared:

Ed Banogon
Company Authorized Representative Member Signature over Printed Name
24/7 Customer Service Hotline: +63 (2) 8462 1800
Outside Metro Manila (Toll Free for PLDT): 1-800-1888-3230
www.philcare.com.ph
White - PhilCare's Copy Yellow - Provider's Copy Pink- Issuer's Copy