Scribd Logo
Upload

Welcome to Scribd!

  • EDPMS - Service Request Form 2023

    Uploaded by

    Arnel Lajo Fulgencio
    12 views1 page
    This document is a service request form from Annie Rose Daniels of the Quilano Clinic and Hospital Incorporated requesting activation of their Electronic Drug Price Monitoring System for the year 2023. It contains details of the request such as the requester's name, office, address, contact information, and a description of the specific request. Relevant approvals and notes on actions taken will be recorded on the form.

    Original Description:

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a service request form from Annie Rose Daniels of the Quilano Clinic and Hospital Incorporated requesting activation of their Electronic Drug Price Monitoring System for the year 2023. It contains details of the request such as the requester's name, office, address, contact information, and a description of the specific request. Relevant approvals and notes on actions taken will be recorded on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    12 views1 page

    EDPMS - Service Request Form 2023

    Uploaded by

    Arnel Lajo Fulgencio
    This document is a service request form from Annie Rose Daniels of the Quilano Clinic and Hospital Incorporated requesting activation of their Electronic Drug Price Monitoring System for the year 2023. It contains details of the request such as the requester's name, office, address, contact information, and a description of the specific request. Relevant approvals and notes on actions taken will be recorded on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Electronic Drug Price Monitoring System

    Ptrarmaceutical Division
    Service Request Form

    D#dReqlest 01r1orfr23

    *'c*fXffiiuen ANN]E ROSE DANlS


    Ld ia.lE First ilarrc lI(*fl.t!.
    Otrce. Qu IJANO CLII{'C AND HOSPITAT INCORPORATED
    I
    AddESS: NANONAL HIGHI,VAY, BRGY BUENAFLOR, TACURONG C|IY
    I
    LerdliE. 06.4.2oo1,.77 6)Fdr*o. W47Z 04.37 7) r/ffiilB ltlo. m07 258 8167
    Erl-t#ess quijano_ 1968@yahoo.com / annroseg0g@yahoo.cont
    mSCR PIXTil (,F REOUEyT: e* Mly t',ite tun ilE ffi d tl?e tq,re6i)
    ACTIVATIOT{ FOR THEYEAR 423

    ,
    AppRolrED Bt: ,',,o..,= o. #*rLLo, rD,FpAFp,rorcA o1,v-,g
    Nane & Wcf
    EOrc t recrdk
    tled cf ofice Dee Sigted

    Pcitbn

    lFor Phamaceurical Dtuisbr ffi (}dyl

    D* Reoeired (mm*ldlyyytfl: I I ]-rrle R€oeit ed (tfrmm) :_ OAl, OPlil


    ACnOflS TAKEIt (Use separale stlee{ if neessary)
    DATE TE ACTOO{TAIGN ACTDI{ OFFrcER SreNANNE
    (a) (b) (c, (d) {e)

    iOTED BY

    tEnead Sigare of SrFvistr PcitiIl D& S€ned

    You might also like