Valenzuela Medical Center
Medical Record System
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Download Claim Slip
Patient Details
Status:
In-Patient:
Date of Admission:
Date of Discharge:
OPD:
Date of Consultation:
Date of Requested:
Date of Released:
Lastname:
Firstname:
MiddleName:
Birthday:
Email Address:
Mobile Number:
Hospital Number:
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Reminder:
Please provide a copy of the proof of payment upon claiming of requested documents
Present a valid government ID of the patient together with the claim slip and official receipt upon claiming of requested documents
If the requester (not the patient) will claim the document, in addition, also present and requester's government ID as well as the patient's government ID and authorization letter signed by the patient
Saturday, Sunday & Holiday requests will be processed on the following working day
For laboratory/Imaging & histopath, charges will depend on the number of examination done
Request for sickness notification (employed/self-employed) and disablity claim are not included in this application
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SUMMARY
The total cost consist of the sub total and service charge
Sub Total
₱
Processing Fee
₱
0
Payment Method Fee
0
%
Total
₱
0
