Print Certification on the Number of Phic Members and Dependents Served
2
CERTIFICATION ON THE NUMBER OF PHIC MEMBERS AND DEPENDENTS SERVED I. Province: LANAO DEL SUR II. Municipali!: DITSAAN RAMAIN III. Na"e o# PCB Provi$er: RURAL HEAL TH UNIT DITSAAN RAMAIN IV. Co"plee A$$re%%: BAGO-A-INGUD, DITSAAN RAMAIN, LANAO DEL SUR PCB Provider Applicable !ar"er Spo#$or N!%ber o& a$$i'#ed &a%ilie$ per %a$"erli$" N!%ber o& e#li$"ed %e%ber$ N! %ber o& e#li$"ed depe#de# "$ N!%ber o& pro(led %e%ber$ N!%ber o& pro(led depe#de#"$ A%o!#" & ' (UARTER )*+& DOH,NHTS +-)+ * * * * T oal +-)+ * * * * T'i% i% o cer i#! 'a 'e #o reoin $aa an$ in#or"a ion are rue a n$ correc an$ e/rac e$ #ro" 'e r epor% %u0"ie$ 0 ! 'e PCB Pro vi$er . Prepare$ 0! : Noe$ 0!: NORO1,ANAH D. MACAPODI2 RN2 RM2 MP A NORMA11AH M. DIMA1OT AN3,A1ONTO2 MD PCB+ Provi$er Sa4 RHP Dae: 5ANUAR6 +72 )*+7 Dae: 5ANUAR6 +72 )*+7
description
jkgv
Transcript of Print Certification on the Number of Phic Members and Dependents Served
7/17/2019 Print Certification on the Number of Phic Members and Dependents Served
http://slidepdf.com/reader/full/print-certification-on-the-number-of-phic-members-and-dependents-served 1/2
CERTIFICATION ON THE NUMBER OF PHIC MEMBERS AND DEPENDENTS SERVED
I. Province: LANAO DEL SUR
II. Municipali!: DITSAAN RAMAIN
III. Na"e o# PCB Provi$er: RURAL HEALTH UNIT DITSAAN RAMAIN
IV. Co"plee A$$re%%: BAGO-A-INGUD, DITSAAN RAMAIN, LANAO DEL SUR
PCB
Provider
Applicable
!ar"erSpo#$or
N!%ber o&
a$$i'#ed
&a%ilie$ per
%a$"erli$"
N!%ber
o&
e#li$"ed
%e%ber$
N!
%ber
o&
e#li$"ed
depe#de#
"$
N!%ber o&
pro(led
%e%ber$
N!%ber o&
pro(led
depe#de#"$
A
&'
(UARTER
)*+&
DOH,NHTS +-)+ * * * *
Toal +-)+ * * * *
T'i% i% o ceri#! 'a 'e #oreoin $aa an$ in#or"aion are rue an$ correc an$ e/race$ #ro" 'e repor% %u0"ie$ 0! 'e PCB Prov
Prepare$ 0!: Noe$ 0!:
NORO1,ANAH D. MACAPODI2 RN2 RM2 MPA NORMA11AH M. DIMA1OTAN3,A1O
MD
PCB+ Provi$er Sa4 RHP
Dae: 5ANUAR6 +72 )*+7 Dae: 5ANUAR6 +72 )*
7/17/2019 Print Certification on the Number of Phic Members and Dependents Served
http://slidepdf.com/reader/full/print-certification-on-the-number-of-phic-members-and-dependents-served 2/2
