Republic of the Philippines

Province of Camarines Sur

Municipality of Calabanga
Barangay Government of San Lucas

ENDORSEMENT LETTER

Date: ___________________

TO: MARIA ESTRELLA LITAM, MD, FPPS, FPIDSP, MBA-H

Medical Center Chief II
Bicol Medical Center
Thru: MR. MARIO CECILIO R. CHAVEZ
Blood Program Coordinator
Sir/Madam:
The Municipality of Calabanga, Barangay San Lucas would like to
endorse our constituent/member of our community that the patient will need
during the stay in your facility.
Herein is the data of our constituent/member of our community.
Name of Patient: ______________________________________ Age: ______ Sex:
______
Address:
_____________________________________________________________________
Hospital Admitted: _______________________________ Ward:
_____________________
Number of Blood Unit/s used: _________________________ For use:
________________
Existing Blood Deposits: ______________________________ As of:
__________________
Blood units to be deducted from the blood stock of the barangay:
_____________
In relation to this, May we humbly ask your good office to give
necessary assistance to the patient. Hoping for your favorable response
regarding this matter. Thank you very much.
Authorized By:
DOMINADOR S. AZAES JR.
_____________________________
Punong Barangay

Program Coordinator

EDUARDO A. SEVERO
Municipal Mayor