Out-Patient Record Request (Form)
*For patients seen and checked at OPD-ER only*
- Fill in all the needed information and click submit.
- Our Medical Records Staff will contact you for confirmation.
- Processing of the request is 4 working days upon receipt of the request.
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)
Request Medical Record for patients seen at OPD-ER and not admitted.