NAGUILIAN DISTRICT HOSPITAL

“PhilHealth Accredited Health Care Provider”

ANNEX D.1

CERTIFICATION OF SERVICE DELIVERY SUPPORT

(Laboratory and Diagnostic Services)

This is to certify that our institution is PhilHealth accredited/DOH licensed and is contracted
referral facility and/or service provider in behalf of DOÑA DONATA DUMUK AGUILA
MEMORIAL HEALTH CENTER for the PhilHealth Konsulta Package from JULY 1,
2022 to DECEMBER 31, 2025. As a Service Delivery partner, we shall provide the
following services:

Laboratory
CBC w/ Platelet count Oral Glucose Tolerance Test (OGTT)
Fasting Blood Sugar Pap Smear/VIA
Fecal Occult Blood Sputum Microscopy
Fecalysis Urinalysis
Lipid Profile Creatinine
HbA1c

Diagnostic
Chest X-Ray
ECG

Further, this institution shall not charge any fees directly from the referred patient but shall
create the billing and payment arrangement with Doña Donata Dumuk Aguila Memorial
Health Center for services provided.

This certification is being issued for PhilHealth accreditation and monitoring purposes.

CERTIFIED BY: CONCURRED BY:

DAN WILLIAM Y. DACANAY II, MD, DFM ERWILL O. NUNAN, MD

OIC-Chief of Hospital Municipal Health Officer

2nd Floor, Provincial Capitol, City of San Fernando, 2500 La Union

(072) 888-3608; (072) 888-6035 (072) 888-4453
govpacoy@launion.gov.ph
 NAGUILIAN DISTRICT HOSPITAL
“PhilHealth Accredited Health Care Provider”

Date Signed: _______________________ Date Signed: ______________________

2nd Floor, Provincial Capitol, City of San Fernando, 2500 La Union

(072) 888-3608; (072) 888-6035 (072) 888-4453
govpacoy@launion.gov.ph