What Are the Requirements for Medical Assistance

What are the Requirements for Medical Assistance?
Request for Medicines

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Letter of request addressed to the Hon. Chairman and/or General Manager
Original/or certified true photocopy of medical abstract duly signed by the attending physician.
(Note: Include physician's license number)
Prescription duly signed by the attending physician with costing from the hospital pharmacy
included:

In cases wherein medicines are unavailable from the Hospital Pharmacy, a Certification on unavailability of medicines
from the Hospital Pharmacy must be submitted to PCSO.

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Photocopy of identification card with latest picture of the requesting person with his/her signature
indicated at the back.

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Request for Laboratory/Diagnostic Procedures

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Letter of request addressed to the Hon. Chairman and/or General Manager
Original/or certified true photocopy of medical abstract duly signed by the attending physician.
(Note: Include physician's license number)
Request from the attending physician duly signed (Note: Include physician's license number)
Official Price Quotation from the Laboratory Section/Department of the Hospital

In cases wherein Laboratory/Diagnostic Procedure is unavailable from the hospital, a Certification on unavailability of
the procedure from the hospital must be submitted to PCSO.

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Photocopy of identification card with latest picture of the requesting person with his/her signature
indicated at the back.

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Request for Payment Hospitalization

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Letter of request addressed to the Hon. Chairman and/or General Manager
Original/or certified true photocopy of medical abstract duly signed by the attending physician.
(Note: Include physician's license number)
Statement of Account/Hospital Bill certified by the billing Officer/Credit Supervisor.
Endorsement letter from the hospital's Social Service if there is any, or from the Credit and
Collection Officer for Pay patients.

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Francis Manalad
Chief Lottery Ops. Officer
Diego Apartment Bayanihan
Nueva Ecija
Tel. No: (044)9762906
Fax No: (044)4866066
0918-607-8708

INDIVIDUAL MEDICAL ASSISTANCE PROGRAM (IMAP)

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nder this program, medical assistance is given to individual patients through the issuance of guarantee letters

to hospitals where the patients are confined. A guarantee letter is a certification issued to hospitals for a particular
charity patient under the PCSO medical assistance program where the agency assumes the obligation of settling the
cost of hospitalization, including the medicines, medical, surgical or blood supplies, and diagnostic procedures.

OBJECTIVES
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General : Restoration of social functioning (Physical recovery) through medical assistance
Specific : Provide assistance for hospitalization expenses, laboratory procedures and purchase of
medicines, chemo drugs, dialysis solutions, antibiotics, implants, devices and other medical needs.

DOCUMENTATION REQUIREMENTS
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Letter Request to Chairman/General Manager
Medical Abstract
Bill/Quotation/Costing from Hospital Pharmacy/Supplies
Laboratory Request/Medicine Prescription
Endorsement/Acceptance letter from Hospital Social Services/Credit Collection Office