HOME VISIT REPORT

JP Morgan Chase and Co.

Active One Health

Patient Information

Patient’s Name: Mengote, Joanne LOB: Consumer & Community Banking

Team Manager: Mabelle Jariol Sex: F SID: 0529610
Authorizing HRBP: Fatima Cojuanco Date requested: Jan. 24, 2014
Home Visit Nurse: Joyce Anne Valladolid Date completed: Jan. 28, 2014
Medical Reason for Home visit: Bone Condition
Primary Address: 44 Christine St. Parkway Village, Brgy Samson, Quezon City
Contact number: 02 386 6064 LCC: 040430- Loss Claims Mgmt- Manila

Home Visit

Arrival time: 1:40 pm Departure Time: 2:00pm

Employee is At home X Not at home
If EE is not at home Name of Informant: Alfred Abillar
Relationship to EE: Brother
Current location of EE: cannot be identified by the informant

Details of Home Visit:

It was 1:40 pm when I reached the location of the employee’s house. I knocked several
times until somebody opened the gate. Then, I started asking if it was the house where Ms.
Joanne Mengote is residing. The lady told me that the employee was her niece, but her real
address is not the same with the one indicated in her profile.

So showed me where the employee’s house is located. After arriving at the said house, a
resident of the house opened the gate and I inquired about the employee and told him my
purpose for visiting their home. He confirmed that the employee resided in the address given.
He told me that the employee is his sister.

Unfortunately, the employee was not at home at that time. The informant didn’t know
where she went. He affirmed that the employee was absent for several days (not specified)
after complaining back pain and that she already went to seek consultation. He said that the
employee is now fine and can stand and move with ease.

After the visit, I reminded the informant to tell the client to go to the company clinic to
be evaluated and considered fit to work.
 EXPENSE REPORT

Departure time: 10:44 am

Arrival at EE’s home: 1:40 pm
Arrival at home: 3:45pm

 Jeep from Enterprise Building to MRT Ayala Station - P 8.00

 MRT Ayala Station to Araneta – Cubao Station - P 12.00
 Jeep from Cubao to Tomas Morato Avenue - P 8.00
 Jeep from Tomas Morato Ave. to Fisher Mall - P 8.00
 Jeep from Fisher Mall to Muñoz (Parkway Village) - P 8.00
 Tricycle from Muñoz to Christine St. - P 20.00
 Tricycle from Christine St. to Muñoz - P 20.00
 Jeep from Muñoz (Parkway Village) to Quiapo - P 15.00
 Jeep from Quiapo to Pedro Gil - P 10.00
 Jeep from Pedro Gil to BCDA - P 28.00
- P 137. 00