*For patients seen and checked at OPD-ER only*

1. Fill in all the needed information and click submit.
2. Our Medical Records Staff will contact you for confirmation.
3. 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)