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: 2

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

A0JYH90 BALLESTEROS, HONEY BELLE V 27 Female

A0JYHF0 CAPORTE, E-JAY P 26 Male
A0JYHJ0 FERRER, ANDREW G 26 Male
A0JYHN0 LACAMBRA, ERICK U 32 Male
A0JYHO0 LIBROJO, JEFFREY F 34 Male
A0JYHV0 SAN JUAN, WILBERT IAN M 29 Male
A0JYHW0 SANTILLAN, SHEILA-MAYE F 30 Female
A0JYHX0 TOLENTINO, EMERSON D 31 Male
A0JYHY0 TOLENTINO, JAYSON D 30 Male
A0KRAM0 GUTIERREZ, JERICO 25 Male
A0Q79F0 DIANO, RONALD T 42 Male
A0QXMK0 IBE, MARK KEVIN I 29 Male
A0QXML0 LAURENTE, KATHLEEN JOY B 25 Female
A0QXMM0 CORPUZ, JOHN ASHLEY B 25 Male
A0QXMQ0 ARENAS, KATHERINE JOY M 25 Female
Total count : 15

PLEASE ATTACH THIS ADVICE UPON SENDING US THE BILLING STATEMENT.

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

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