MEDICAL SERVICES DIVISION

LETTER OF ENDORSEMENT FOR ANNUAL PHYSICAL EXAM (APE)

To:
Date
HI-PRECISION DIAGNOSTICS (COMMONWEALTH BRANCH)

ATTENTION TO : MS. AMELYN ACEBO

January 09, 2024

APE SCHEDULE : Mon - Sat 7AM - 3PM

CLINIC SCHEDULE : Mon - Sat 6AM - 4PM PHILCARE Sales Services

CONTACT NO. : (02) 8273-0874

From:
Pascual, Marla
NOTES :

# of pages including cover: 1

CLIENT CONTACT NUMBER:
ACCOUNT TEL NUMBER: SENDER TELEPHONE NUMBER:
PROVIDER FAX NUMBER:
(02) 802-7333 Loc 17230 / 17228

PROVIDER PHONE NUMBER: ENDORSED BY:

(02) 8273-0874/8285-0928 Bagasin, Ryan A.

APPROVED BY:
RE: ANNUAL PHYSICAL EXAM
Samonte, Jose E. Jr. RN

SMARTGEO SURVEYING AND GEOMATICS

Account Name: Agreement #: PC13521

Date of APE: 01/10/2024 - 02/10/2024 Effective Date: 05/27/2023 - 05/26/2024

APE Package: Medical History+PE,CBC,Urinalysis,Fecalysis,Chest X-Ray

ECG for members 35 y/o and up,Pap Smear for female members 35 y/o & up

Additional APE
Procedure

Remarks:
**Results shall be pick up by the Member/s
Certificate# Name Age Sex Signature Date

A0WFNU0 BARTOLOME, KENDRICK 27 Male

Total count : 1

PLEASE ATTACH THIS ADVICE UPON SENDING US THE BILLING STATEMENT.

CLAIM DOCUMENTS WITHOUT THIS ATTACHMENT WILL NOT BE PROCESSED.
THANK YOU

4th and 5th Floor, STI Holdings Center, Philfirst Building, 6764 Ayala Ave, Makati City