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    Member Data Record: Philippine Health Insurance Corporation

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    Diane Mary
    This document is a Member Data Record (MDR) from the Philippine Health Insurance Corporation containing personal information and coverage details of Mary Dyanne PMilacan. It lists her PhilHealth Identification Number, member category, name, date of birth, address, contact information, and indicates she has no declared dependents. The record reminds the member to check for accuracy and protect the confidentiality of the MDR document.

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

    Member Data Record: Philippine Health Insurance Corporation

    Uploaded by

    Diane Mary
    14 views1 page
    This document is a Member Data Record (MDR) from the Philippine Health Insurance Corporation containing personal information and coverage details of Mary Dyanne PMilacan. It lists her PhilHealth Identification Number, member category, name, date of birth, address, contact information, and indicates she has no declared dependents. The record reminds the member to check for accuracy and protect the confidentiality of the MDR document.

    Original Title

    012577768798

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    This document is a Member Data Record (MDR) from the Philippine Health Insurance Corporation containing personal information and coverage details of Mary Dyanne PMilacan. It lists her PhilHealth Identification Number, member category, name, date of birth, address, contact information, and indicates she has no declared dependents. The record reminds the member to check for accuracy and protect the confidentiality of the MDR document.

    Copyright:

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

    Member Data Record: Philippine Health Insurance Corporation

    Uploaded by

    Diane Mary
    This document is a Member Data Record (MDR) from the Philippine Health Insurance Corporation containing personal information and coverage details of Mary Dyanne PMilacan. It lists her PhilHealth Identification Number, member category, name, date of birth, address, contact information, and indicates she has no declared dependents. The record reminds the member to check for accuracy and protect the confidentiality of the MDR document.

    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


    Lucena Grand Central Terminal, Brgy. Ilayang Dupay, Lucena City
    (042) 373 6936 (042) 373 7056 (042) 373 6703 to 04 (042) 373 6704 (fax)
    www.philhealth.gov.ph MDR
    MEMBER DATA RECORD
    MEMBER INFORMATION

    PhilHealth Identification Number (PIN): 012577768798


    Member Category : INFORMAL ECONOMY NHTS Coverage :
    Sub-Category : SELF-EARNING INDIVIDUAL Effectivity Period :

    DE JESUS, MARY DYANNE PMILACAN


    027 DAMA DE NOCHE, BUBUKAL, STA.
    CRUZ, LAGUNA

    Foreign Address : N/A Sex : Female


    Date of Birth : 02/28/1998
    Place of Birth : STA. CRUZ, LAGUNA

    Contact No. (Foreign) : N/A Civil Status : SINGLE


    (Local) : (501)908-7 Tax Identification Number:
    EMPLOYER/ORGANIZED GROUP INFORMATION
    Philhealth Number (PEN/POGN) : N/A
    Name of Employer/Organized Group : N/A
    Business Address : N/A

    Telephone Number : N/A


    Tax Identification Number : N/A
    DEPENDENT INFORMATION
    PIN Surname Given Name Middle Name Sex Relation Date of Birth

    *** NO DECLARED DEPENDENT/S ***

    *** NOTHING FOLLOWS ***

    ELIZABETH S. FERNANDEZ, MD
    REGIONAL VICE PRESIDENT, PRO IV-A
    PRO IV-A Lucena City

    Paalala : Basahin ang nilalaman ng MDR. Kung may kulang o mali, ibalik agad upang maidagdag o maiwasto. Ingatan ang orihinal na
    kopya at huwag ibigay kahit kanino. Kung sakaling gagamit at makikinabang ng benepisyo, magbigay ng kopya sa ospital.Read the
    (Reminder:
    contents of the MDR. Should there be any data discrepancies, return it back to amend or rectify the error. Take good care of the MDR and do not hand it over to anybody.
    Provide photocopy to hospital in case of confinement and availment of benefits.)

    This is a system generated report. Signature is not required.


    6/27/2018 8:48:09 AM 21001510 21001510 / / 6/27/2018

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