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    Pbef 9426199

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    glay
    This document is a certificate of eligibility from the Philippine Health Insurance Corporation (PhilHealth) for Apple Grace de Castro. It provides her PhilHealth identification number and confirms she is eligible for PhilHealth benefits. It also lists the health care institution where she was admitted, her patient information, and serves as documentation that can be submitted to PhilHealth for her claim. It reminds users that printing this form is free for beneficiaries and notes some conditions and limitations regarding her eligibility and claims.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Pbef 9426199

    Uploaded by

    glay
    134 views1 page
    This document is a certificate of eligibility from the Philippine Health Insurance Corporation (PhilHealth) for Apple Grace de Castro. It provides her PhilHealth identification number and confirms she is eligible for PhilHealth benefits. It also lists the health care institution where she was admitted, her patient information, and serves as documentation that can be submitted to PhilHealth for her claim. It reminds users that printing this form is free for beneficiaries and notes some conditions and limitations regarding her eligibility and claims.

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    PBEF-9426199-39d0934a7fdf8297ec9f3a09722b7cf6

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    This document is a certificate of eligibility from the Philippine Health Insurance Corporation (PhilHealth) for Apple Grace de Castro. It provides her PhilHealth identification number and confirms she is eligible for PhilHealth benefits. It also lists the health care institution where she was admitted, her patient information, and serves as documentation that can be submitted to PhilHealth for her claim. It reminds users that printing this form is free for beneficiaries and notes some conditions and limitations regarding her eligibility and claims.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    134 views1 page

    Pbef 9426199

    Uploaded by

    glay
    This document is a certificate of eligibility from the Philippine Health Insurance Corporation (PhilHealth) for Apple Grace de Castro. It provides her PhilHealth identification number and confirms she is eligible for PhilHealth benefits. It also lists the health care institution where she was admitted, her patient information, and serves as documentation that can be submitted to PhilHealth for her claim. It reminds users that printing this form is free for beneficiaries and notes some conditions and limitations regarding her eligibility and claims.

    Copyright:

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

    Republic of the Philippines

    PHILIPPINE HEALTH INSURANCE CORPORATION


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

    Bawat Pilipino Miyembro, Bawat Miyembro Protektado, Kalusugan Natin Sigurado

    Date & Time of Generation : February 17, 2023 23:29:59 PM


    CEWS Tracking Number : Z060562302000017

    HEALTH CARE INSTITUTION (HCI) INFORMATION

    Name of Institution : SANTA ROSA CHO-I BIRTHING CENTER


    Accreditation No. : M41029436

    MEMBER INFORMATION

    PhilHealth Identification No. : 082526737292


    Name of Member : ALCURAN, APPLE GRACE DE CASTRO
    Sex : Female
    Date of Birth : August 29, 2000
    Member Category : SPONSORED - POS-FINANCIALLY INCAPABLE

    PATIENT INFORMATION
    Name of Patient : ALCURAN, APPLE GRACE DE CASTRO
    Date Admitted : February 15, 2023
    Sex : Female
    Date of Birth : August 29, 2000

    ELIGIBILITY INFORMATION
    ELIGIBLE TO AVAIL PHILHEALTH BENEFITS? = YES

    DOCUMENTS TO BE SUBMITTED TO PHILHEALTH

    Important Reminders:
    1. Generation and printing of this form is FREE for all PhilHealth Beneficiaries.
    2. If the Electronic Claims Submission is not yet implemented, 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 CONFINEMENT (SPC). It shall be established when the claim is processed by PhilHealth.
    Non-qualification to the rule of SPC shall result to denial of this claim.
    4. *Corresponds only to the paid claim as of the date and time of generation. PhilHealth Benefit Claims that are in transit or on process are not yet included.

    Member / Representative Module 1 CEWS User


    Signature Over Printed Name / Thumbmark Signature Over Printed Name

    Philippine Health Insurance Corporation


    Citystate Center, 709 Shaw Boulevard, Pasig City. HealthLine: 441-7444

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