Fax

Date November 08, 2018

To: LOPEZ DISTRICT FARMER'S HOSPITAL. INC
Tel & Fax number (034) 476-2722
Page/s
Subject: Annual Physical Examination
Account Number 80-38-00212 / 1
Account Name ORGANIC PRODUCERS IN THE ISLAND OF NEGROS -MULTI-PURPOSE COOPERATIVE
Valid From 11/8/2018
Valid To 11/11/2018

This is to endorse the Annual Physical Examination of below listed member/s from
ORGANIC PRODUCERS IN THE ISLAND OF NEGROS -MULTI-PURPOSE COOPERATIVE on November 8-11, 2018 only.

BUYCO, ALAN D 80-38-00212-00003-00

The members will undergo the following procedures:

APE BASIC 5 (Physical Exam, Urinalysis, Fecalysis, CBC, Chest Xray)
12LEAD ECG (For members age thirty-five (35) years and above)
PAPSMEAR (For female members age thirty-five (35) years and above)

Please attach the endorsement letter to your billing and members will personally pick up the results to avoid
any delays.

Note:
> The patient should present his/her Intellicare card and any valid ID prior to availment.
We are implementing a NO ID, NO APE POLICY.

We hope that you will find the above details in order. Should there be any question, please feel
free to call our office (Account Management-APE Section: Tel. No. ( 034 ) 709-9889 / 433-1984 I Fax: 709-9889

Thank you. Noted by:

(SGD) (SGD)
IAN PHILIP S. LONGNO ANGEL LOU D. CUACHON
APE/PPE Coordinator Sr. Asst. Manager / CEMT
Account Management