Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Citystate Centre Building, 709 Shaw Boulevard, Pasig City
Healthline: 441-7444 Website: www.philhealth.gov.ph

Date & Time of Generation : APRIL 29, 2024 08:11:35 AM

HCI Portal Reference No. : BEF100000059584295
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HEALTH CARE INSTITUTION (HCI) INFORMATION
Name of Institution : NABILOG COMMUNITY PRIMARY HOSPITAL
Accreditation No. : H07021327
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MEMBER INFORMATION
PhilHealth Identification No. : 122250065459
Name of Member : AMIHOY , ETHEL ANTANOY
Sex : FEMALE
Date of Birth : JANUARY 21, 1991
Member Category : FORMAL ECONOMY - HOUSEHOLD HELP/KASAMBAHAY

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PATIENT INFORMATION
Name of Patient : AMIHOY , ETHEL ANTANOY
Date Admitted : APRIL 28, 2024
Sex : FEMALE
Date of Birth : JANUARY 21, 1991
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ELIGIBILITY INFORMATION
ELIGIBLE TO AVAIL PHILHEALTH BENEFITS? = YES

Reason/s:

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Attached Documents:
N/A
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Important Reminders:
1. Generation and printing of this form is FREE for all PhilHealth Beneficiaries.
2. This form shall be submitted along with the required PhilHealth claims forms and is valid only for the confinement/admission stated above.
3. This does not include eligibility to the rule of SINGLE PERIOD OF CONFINEMENT(SPC). It shall be established when the claim is processed by PhilHealth.
Non-qualification to the rule on SPCshall result to denial of this claim.
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