Republlc of the Phlppines

PHIIPPINE
FGAYEWÄY
HEALTH INSURANC CENTER, C.M. RECTO AVE.. CAGAYAN DE ORO CITY
Call Center (02) 441-7442, Landline: (088) 856-1780
www.phihealb.gOY.ph
MDR
MEMBER DATA RECORD
MEMBER INFORMATION
PhilHealth ldentification Number (PIN) : 152514004875
NHTS Coverage
Member Categdry :INFORMALECONOMY
Effectivity Period
Sub-Category, :INFORMALSECTOR

PAGUIRICGAN, DERICK TON DEL PUERTO

LOT 5 ZONE 9 MALASAG ROAD ILAYA,
CUGMAN, CAGAYAN DE ORO CITY.
MISAMIS ORIENTAL 9000

Foreign Address N/A Sex Male

Date of Bith :12/17/2000
Place of Birth CAGAYAN DE ORO CTY, MISAMIS ORIENTAL

Civil Status :SINGLE

Contact No. (Foreign) N/A
(Local) Tax ldentification Number
EMPLOYERORGANIZED GROUP INFORMATION
Philhealth Number (PENPOGN) NA
Name ofEmployer/Organized Group NA
Business Address NA

Telephone Number NA

Tax ldentification Number N/A

DEPENDENT INFORMATION
Given Name Middle Name Sex Relation Date of Birth
PIN Surname

NO DECLARED DEPENDENT/S
NOTHING FOLLOWS

PHILHEALTH PRO-X
RELEASED
27 JAN 2927
Hh.cho
*
DELIO A. ASERON, U
REGIONAL VICE PRESIDENT
.

PRO-X Cagayan De Oro City

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kopya at huwag ibigay kahit kanino. Kung sakaling gagamit at makikinabangng benepisyo, magbigay ng kopya sa ospital. eminer d the
contents of the MDR Should there be ary data disorepancles, returnt back to amend or rectily the emor. Take good cane of the MDR and do rot hand k over fo anybody.
Prvide photocopy to hosphal in case of conlinement and avaliment od bnefits)
This is a system generated repon. Signature is not required.
01/27/20222:2321 pm 20493114 30493114 01/27/2022