Name of PCB Provider:

RHU-NEW BATAAN

RHU Accreditation Number: 11179008

Column A

Column B

MEMBER PIN

LAST NAME

230045620811

COMPACION

230045620811

COMPACION

230045620811

COMPACION

230045620811

COMPACION

230045620811

COMPACION

162011562590

DAUHOG

1620116332114

SADYA

1620116332114

SADYA

230045619988

TAYABAS

162520526404

TAYABAS

162520526412

TAYABAS

162520526420

TAYABAS

162520526439

TAYABAS

162520526447

TAYABAS

162520526447

TAYABAS

230045620072

DAUHOG

230045620072

DAUHOG

230045620072

DAUHOG

162002819295

DUBLAS

162002819295

DUBLAS

JULIET M. ORACION, RM

Prepared by:

MIDWIFE II

Annex A

Name of PCB Provider:

RHU-NEW BATAAN

RHU Accreditation Number: 11179008

Column A

Column B

MEMBER PIN

LAST NAME

162002819295

DUBLAS

162002819295

DUBLAS

230045620838

TOMANDO

230045620838

TUMANDO

230045620005

TOMANDO

162008850070

BRANDINO

162008850070

BRANDINO

162008850070

BRANDINO

162008854092

RIVERA

162008854092

RIVERA

162008854092

RIVERA

162008854092

RIVERA

162011521843

BALAGA

162011521843

BALAGA

162011521908

BALAGA

162011521908

BALAGA

230045620862

UNABIA

230045620862

UNABIA

230045620862

UNABIA

230045620862

UNABIA

JULIET M. ORACION, RM

Prepared by:

MIDWIFE II

Name of PCB Provider:

RHU-NEW BATAAN

RHU Accreditation Number: 11179008

Column A

Column B

MEMBER PIN

LAST NAME

160254496283

UNABIA

230045620013

BUHISAN

162011632092

SADYA

162011632092

SADYA

162011632092

DIONALDO

162011632092

DIONALDO

230045620846

BAYBAYANON

230045620846

BAYBAYANON

230045620846

BAYBAYANON

230045620013

BUHISAN

230045620064

RAMADA

230045620064

RAMADA

230045620064

RAMADA

Prepared by:

JULIET M. ORACION, RM
MIDWIFE II

TRANSMITTAL LIST

Column C

Column D

Column E

Column F

FIRST NAME

MIDDLE NAME

SUFFIX NAME

DATE OF BIRTH
(mm/dd/yyyy)

FELIPE

LOPEZ

05/24/1968

HARANIA

MONTENEGRO

01/19/1975

MA. FE

MONTENEGRO

3/6/1998

LORIE FE

MONTENEGRO

11/9/2002

MICKEY

MONTENEGRO

8/9/2006

JOEL

MANIGO

1/6/1991

ROGELIO

BARBARONA

GAINEY RUZZEL

NACAYTUNA

JR

2/12/1986
10/9/2011

MANUEL

LANGTAD

9/12/1973

GINA

CUATON

12/25/1978

JERWEN

CUATON

2/7/2002

IAN JADE

CUATON

10/11/2008

MARGIE

CUATON

11/19/2000

JAN IVAN

CUATON

1/1/2004

JUSTINE

CUATON

7/7/2010

DANILO

LIGUID

09/21/1962

FE MILAGROS

CAMPOS

7/11/1957

JONEL

CAMPOS

12/13/1996

ELIAS

ANGANA

1/10/1970

NEDIE

TAYABAS

5/9/1973

TRANSMITTAL LIST

Column C

Column D

Column E

Column F

FIRST NAME

MIDDLE NAME

SUFFIX NAME

DATE OF BIRTH
(mm/dd/yyyy)

ELLA MAE

TAYABAS

5/6/2001

JOHN REY

TAYABAS

03/16/2005

DELFIN

SADYA

6/7/1962

EDIELYN

RESOMADERO

02/22/2005

BERTO

SADYA

8/6/1961

EUFEMIO

GALADO

10/9/1957

CHARITA

SADYA

4/8/1964

MIKI JOHN

SADYA

01/30/1998

DIOMAR

SULLAMILLO

08/22/1977

NERALYN

FANTONEAL

06/15/1977

JONAIRAKYLL

FANTONEAL

03/28/2005

JEFRENCE ANDREI

FANTONEAL

08/16/2008

GRACELYN

CAMPOS

1/2/1986

GABRIEL
GRETCHEN

02/16/2010
CAMPOS

10/24/1987

BELLA ALYSSA

9/5/2013

ROBERTO

PANINSORO

5/2/1964

NORMA

TUMANDO

12/2/1971

MICHAEL

TUMANDO

5/3/1999

MARJORIE

TUMANDO

2/11/2006

TRANSMITTAL LIST

Column C

Column D

Column E

Column F

FIRST NAME

MIDDLE NAME

SUFFIX NAME

DATE OF BIRTH
(mm/dd/yyyy)

REXIL

TUMANDO

03/161990

FRANCISCO

ARANTE

12/9/1948

ENRIQUE

CALOLO

04/23/1977

FAITH

ANTIPALA

12/4/2012

GIRLIE

BALAGA

02/27/1984

JAKE

BALAGA

07/202006

PATRICIO

MAPANDO

03/15/1958

PILAR

SADIA

8/8/1955

JOMAR

SADIA

6/10/1997

LEONORA

MAHINAY

2/1/2028

FERNANDO

LOREMIA

GLORIA

MICULOB

05/14/1972

GLORELYN

MICULOB

05/13/2002

SR.

05/23/1970

Date:

Column G
SEX (M-male /Ffemale)

Column H
CATEGORY
member /

(MD-dependent

MEMBER

DEPENDENT

DEPENDENT

DEPENDENT

DEPENDENT

MEMBER

MEMBER

DEPENDENT

MEMBER

DEPENDENT

DEPENDENT

DEPENDENT

DEPENDENT

DEPENDENT

DEPENDENT

MEMBER

DEPENDENT

DEPENDENT

MEMBER

DEPENDENT

Approved by:

Column I
DATE ENLISTED
(mm/dd/yyyy)

AUREA S. SOLILAP, MD
MUNICIPAL HEALTH OFFICER

Date:

Column G
SEX (M-male /Ffemale)

Column H
CATEGORY
member /

(MD-dependent

DEPENDENT

DEPENDENT

MEMBER

DEPENDENT

MEMBER

MEMBER

DEPENDENT

DEPENDENT

MEMBER

DEPENDENT

DEPENDENT

DEPENDENT

MEMBER

Column I
DATE ENLISTED
(mm/dd/yyyy)

DEPENDENT

MEMBER

DEPENDENT

MEMBER

DEPENDENT

DEPENDENT

DEPENDENT

Approved by:

AUREA S. SOLILAP, MD
MUNICIPAL HEALTH OFFICER

Date:

Column G
SEX (M-male /Ffemale)

Column H
CATEGORY
member /

(MD-dependent

MEMBER

MEMBER

MEMBER

DEPENDENT

MEMBER

DEPENDENT

MEMBER

DEPENDENT

DEPENDENT

DEPENDENT

MEMBER

DEPENDENT

DEPENDENT

Approved by:

Column I
DATE ENLISTED
(mm/dd/yyyy)

AUREA S. SOLILAP, MD
MUNICIPAL HEALTH OFFICER

Column J
DATE PROFILED
(mm/dd/yyyy)

Column J
DATE PROFILED
(mm/dd/yyyy)

Column J
DATE PROFILED
(mm/dd/yyyy)