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EC247884

This document is a Letter of Authorization for outpatient services for patient Zenaida De Borja, diagnosed with hypertensive arteriosclerotic cardiovascular disease. It grants approval for a 2D Echo with GLS study under the MedAsia Phils insurance policy, with a specific approval code. The letter instructs the recipient to submit the original statement of account within 7 days for payment processing.

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Jonah De borja
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36 views1 page

EC247884

This document is a Letter of Authorization for outpatient services for patient Zenaida De Borja, diagnosed with hypertensive arteriosclerotic cardiovascular disease. It grants approval for a 2D Echo with GLS study under the MedAsia Phils insurance policy, with a specific approval code. The letter instructs the recipient to submit the original statement of account within 7 days for payment processing.

Uploaded by

Jonah De borja
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

LETTER OF AUTHORIZATION: OUTPATIENT

APPROVAL CODE NO : EC247884


.

MPI - MEDICAL CENTER


DATE: 4.12.2024 HOSPITAL / CLINIC: MUNTINLUPA Fax no:
Name of Patient: DE BORJA, ZENAIDA COMPANY : DEARBORN MOTORS CO., INC.
Diagnosis: HYPERTENSIVE ARTERIOSCLEROTIC CARDIOVASCULAR DISEASE

This letter of authorization with corresponding approval code serves to acknowledge the out patient availment of the above patient who is a
bonafide member of MedAsia Phils: Integrated Medical Access System (IMAS). Based on the medical insurance policy of the member / patient.
MedAsia Phils. shall cover for:

2D ECHO WITH GLS STUDY

INSTRUCTION: Kindly forward to our office your original statement of account in duplicate with attached copy of this LOA within 7
days from date of availment for immediate processing of payment.

This Letter of Authorization is valid only with the Approval Code. Thank you for your usual cooperation.

Very truly yours,

JACKIE ALCANTARA NOTE: LOA IS VALID FOR 7DAYS UPON ISSUANCE


Operations Coordinator

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