maame: JETWEE_RETAGO CALEWGACTON PRE Rnes Se ‘complete physical examination to inclade visual acuity, coler perception and eral/dental exam) PROG TEST (SAGO OD MARITUWAS ‘RESULTS TO BE PICK UP BY THE APPLICANTIOIVE PID NUMER TO APPLICANT, KINDLY SEND SOFT COPY RESULTS TO THE HR EMAL: Anges tae F.Penones For any concems, kindly email us at ape@etiqa.com ph. Thank yout A pete nth prescipion gles and contact lenses au being he carne sing he examination fo Visual Ast. = For CBC wit platelet count No tastogipreparafon needed + For Blood chemists (eg FBS andipd profie|. cbseve 1Ohour offasing Patent i ot slowed to et or dink unt ood extraction. For rinatyss, une specimen container wl be provided atthe cnc. Kindy colect»mid-tream une sale during the doy of the examination and immecely te laboratiry Females can subata specimen atleast 7 days after fh ast oy of menciaton = For stook analysts. the patent shou colect a peo-cize soa! specimen in the morning betes proceeding othe cic and must be subi tothe aborstory "hears ater cotecton For Chest say. Observe precauton for woman who are suspected tobe pregnant ore pregnant “FOrECG Wear confericle ating wth no metalic acceerenien. ~ For femates undergoing Pap smear, it i recommended by most O5- Gynecalageteical doctors to cbseve the towing ~ To rokan tom somal tercourse fr atleast 2-9 days belore he exam Should not use vaginal daucheflemanine wash 24 hobrsbelore the procedure No Menctrstion-No Spoting preferably 7—10 days afer mentation. = For the drug teat, 2 separate rine contain wil be provided Its acisable io have a lace for the recur eve of une (62 ml). The patents required to rt 2 ald governement fed ID pio ry avatar. PRIVACY POLICY & CONSENT: | forme and on behalf of my depres, sutras Eaga Puppies © process my personal Ga, such ex, bal nok to, my medical agnosiiicaon deta ato sclose the said persone ata necessary tar pares such as, but not tte fo, my employer, scareies Provider, beadquaer, reser, group pokcyaers and audio | undersand Pat he processing of my persnal dea chal be used serving my accent echoes. bt st ited, oe flowing beets scnnkcraton, mecca reatmert, and management of the Han. age to receive matketng Update ond agree to ebtain a copy of my recat elas to my hospiatzatn, consuaton and Weatment any er medial ace m cannecton with te beraifaain UNDERTAKING & REMINDER: Plan Member mest ign AFTER avaiment Unssed LOG should macy be reported to Eigen Phippines’ Account Ent Clearance. Final computation of your coverage wil be mate once ES Pippin’ Medcal Clams Payatien Deparment cicicams your clam any of fe folowing (a) any calles avant) enursoment cams; nde) unprocessed clams that ore yt to beter by te scorched network rier. agree tat any avant may be denied under crcumstancts sich as concealment and procedures net laed tothe tnece | onder ESga PRnppince ree any Seb on te colecton oe acguted exces charges on benef [UNDERTAKING & REMINDER: Network Provider musts AFTER COMPLETION OF SERVICE. Al proceduestets must have prior approval tm Eqs Pipines MIC, Formed lesce sabeat a is itn 30 dys, Accreind Neto Provider shal nly Eqs Pipes yan nck receed wate 30 day fom ese om