Professional Documents
Culture Documents
Blank Form (Health Facility)
Blank Form (Health Facility)
Type of Facility
NAME OF HEALTH COMPLETE ADDRESS CONTACT NUMBER E-MAIL ADDRESS (BHS/ RHU/
FACILIY Level I, II, III)
PHILHEALTH NAME OF OWNER/
ACCRED. VALIDITY DOH LICENSE VALIDITY CONTACT NUMBER EMAIL ADDRESS
MANAGER/ DIRECTOR
Remarks