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    Sophia COC

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    denisse.eleazar18

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    © All Rights Reserved
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    Sophia COC

    Uploaded by

    denisse.eleazar18
    9 views1 page

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    © © All Rights Reserved

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    Copyright:

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    9 views1 page

    Sophia COC

    Uploaded by

    denisse.eleazar18

    Copyright:

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

    HEALTH PARTNERS DENTAL ACCESS INC.

     (632)8 711-0020; Toll Free: 1-800-10-292-2194


    Unit 6, 2nd floor (0922) 842-4514; (0947) 896-4132; (0917)178-8409
    143 Cordillera St.
    Brgy. Maharlika, Quezon City 1114 [email protected]
    www.healthpartnersdental.com

    June 28, 2024

    Dear Doctor,

    Greetings of Good Health!!!

    This is to formally endorse to your office that our New account, LIZARDBEAR TASKING INC./ TASKUS
    OUTSOURCING OHILIPPINES INC., with enrolled EMPLOYEES & ELIGIBLE DEPENDENTS whose
    dental coverage is under Health Partners Dental Access, Inc. While their cards have not been distributed, please
    accommodate our enrolled employees.

    Sophia Bianca M. Abel


    This letter serves to authorize bearer, Mr./Ms.________________________________________________,of the

    above company, with effective date May 1, 2024, is enrolled under HPDAI to avail of his/ her dental benefits listed
    below.

    Call FOR APPROVAL for procedures below:

    Dental Benefits:
    o Oral examination
    o Consultations
    o Orthodontic consultation (braces and malposition of teeth)
    o Pre-natal check of teeth and gums
    o Temporo-Mandibular joint consultation (Clicking of Jaws)
    o Temporary Fillings
    o Re-cementation of jacket crown inlays and onlays
    o Simple Tooth extraction of unsavable tooth
    o Adjustment of Dentures
    o Treatment for lesions, wounds, and burns
    o OTHERS: Additional benefits based on applicable Dental Plan.

    This Certificate of Coverage is Valid until JULY 31, 2024

    If you have any inquiry, please call/text our office at Trunkline 8711-0020/ Toll Free 1-800-10-2922194/ Mobile No.
    (0922) 842-4514; (0917) 538-5111; (0947) 896-4132.

    We assume that all information will be disseminated down to your associates, relievers and secretaries.

    AUTHORIZED BY: ISSUED BY:

    Dr. Jemima De Villa Ana Liza Dagan


    AVP, Operations HRSS Senior Manager
    Kindly fill up information below and attach this LOA to your billing with the completed HPDAI dental availment
    form for processing of claims. Kindly ask for a valid ID for verification of ownership and proof of identification.

    DATE OF AVAILMENT:

    DENTAL CLINIC:
    Sophia Bianca M. Abel
    _________________________________ _______________________________
    DENTIST PATIENT
    SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

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