Republic of the Philippines

Department of Health
MALASAKIT PROGRAM OFFICE

May 09, 2023

CERTIFICATION

This is to certify that patient REY MADRAGON MIARAL, 35 y/o , of BINONDO NCR FIRST DISTRICT, was extended by this office, a total of
Php5,000.00, medical assistance stated below based on the existing guidelines of Administrative Order No. 2020 - 0060, dated December 23, 2020:

Type of Assistance Utilization Remaining Balance Date/Time

Hospital Bills/Diagnostic/Laboratory/Procedures/Radiology/Therapy/Medicines () 0.00 5,000.00

Total Amount P 0.00 P 5,000.00

U-PGH-230509-14238969B8A
GIRLIE E. VELOSO
Director IV

Notes:
50% maximum applicable for PF
Non-Convertible to cash

Encoded by: evp13

STA CRUZ MANILA, 651-7800 Local: 1807, 1810, 1811, 1805, and 2908, doh.gov.ph

-------------------------------------------------------------------------------------------------------------------------

Republic of the Philippines

Department of Health
MALASAKIT PROGRAM OFFICE

May 09, 2023

CERTIFICATION

This is to certify that patient REY MADRAGON MIARAL, 35 y/o , of BINONDO NCR FIRST DISTRICT, was extended by this office, a total of
Php5,000.00, medical assistance stated below based on the existing guidelines of Administrative Order No. 2020 - 0060, dated December 23, 2020:

Type of Assistance Utilization Remaining Balance Date/Time

Hospital Bills/Diagnostic/Laboratory/Procedures/Radiology/Therapy/Medicines () 0.00 5,000.00

Total Amount P 0.00 P 5,000.00

U-PGH-230509-14238969B8A
GIRLIE E. VELOSO
Director IV

50% maximum applicable for PF Recieved by

Non-Convertible to cash ________________________
Signature over Printer Name
Date Recieved: ___________
Encoded by: evp13

STA CRUZ MANILA, 651-7800 Local: 1807, 1810, 1811, 1805, and 2908, doh.gov.ph