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Medical Records Request Form

Medical Records Request Form

Name of Requesting Party:

Instructions:

  1. Please fill in all needed information.
  2. Our Medical Records Staff will contact you for confirmation.
  3. 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)

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