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Medical Records Request Form

Medical Records Request Form

Please fill in all needed information.
Our Medical Records Staff will contact you for confirmation.
Processing of request is 4 working days upon receipt of request.
To ensure patient confidentiality and in pursuance to RA 10173, the following documents are REQUIRED when claiming requested documents.

For Patients:
• Valid Identification Card (any of the following SSS, PHIC, Driver’s License, Passport or Company ID)

For Authorized Representatives
• Authorization Letter from the patient/ legal heirs
• Valid Identification Card of the patient (any of the following SSS, PHIC, Driver’s License, Passport or Company ID)
• Valid Identification Card of the representative (any of the following SSS, PHIC, Driver’s License, Passport or Company ID)

Name of Requesting Party:

 

For follow up and queries please contact Medical Records Department on the following numbers
Telephone Number: (082)222 - 8000 locals 1136 and 1541
Email Add: medicalrecords@ddh.com.ph or ddhmedical.records@gmail.com