philippine health insurance corporation · republic of tile philippines philippine health insurance...
TRANSCRIPT
Rl!publlc of tile Plllllpp/ues PHILIPPINE HEALTH INSURANCE CORPORATION
Citystatc Cchti·c lluiidihg. 709 Silnw Bouh!Vard, Pnsig City llealthline 441-7444 www.philheuhh.gnv.ph
'I
June 20, 2012
PHILHEALTH CIRCULAR No.~s. 2012
-R.4 TO ALL PHILHEALTH MEMBERS, ACCREDITED PROVIDERS
PHILHEALTH REGIONAL OFFICES (PROs) AND ALL OTHERS CONCERNED
SUBJECT: Supplemental Guidelines to PhilHealth Circular 15 s . 2012 Re: PhilHealth for Animal Bite Package (Rabies P ost-exposure Prophylaxis)
Tn order to facilitate implementation of Animal Bite Package (ABP) and hasten participation of interested providers o f this package, the following additional guidelines shall be followed:
A. Provider Engagement 1. l'o r CY 2012, in lieu of the Certificate of Recognition as an .Animal Bite Treatment Center
o r Animal Bite Center from the DOH, all ABTCs and ABCs found in Annex A, a ligt of facilities capable of managing animal bites as certified by the DOH-NCDPC, shall be eligible to participate as providers for the ABP. These facilities are given until July 31, 20 12 to submit the provider's data record and signed PC fo r HCP in order to receive reimbursement.
2 . Submission o f the Certificate o f Recognition from the DOH as an ABTC/ ABC shall follow upo n issuance by said DOH office / s or upon renewal o f participatio n in the Program, whichever co mes firs t.
3. H CPs with intention to participate shall usc the Perfo rmance Commitment (PC) fo r Hcnlth Care Providers (HCP) attached to PhiiHcalth Circular 13 s. 2012.
4. 1\ BP provider which submitted provider's data reco rd (PDR) and signed P C o n o r before July 31,2012 shall be eligible fo r reimbursement beginning !\:lay 3, 2012. This means that treatment provided to Phi\Health members starting May 3, 2012 will be retroactively computed and reimbursed .
5. PDR and signed PC submitted after July 31, 2012, shall render the provider eligible for reimbursement of claims for comple ted treatment beginning on the date it complied with the requirements as stated .in l)hi\Health Circular 13 s. 2012. Claims filed for comple ted treatment prior to the date of co mpliance will NOT be reimbursed .
() . Direct ft.le from patients from May 3, 2012 may be reimbursed provided that the claims arc flied within 60 days from completion o f day 7 trentment or in cases mentio ned in U.1 of the circular, in any o f the r\TITCs in the list.
7. Fo r direc tly ftled claims, the beneficiary shall submit claim form 2 and a certjfied true copy of the completely filled -out Animal Bite Treatment Record.
8. 1\ll THCPs eligible as provider o f 1\ BP shall put a signage fo llowing the attached design and technical specifications. (Annex B)
h:amphilhealth
Republic of tile Philippines PHILIPPINE HEALTH INSURANCE CORPORATION
B. Benefits Availmeot
Citystale Ct:nu·t: Building, 709 Shaw Boult:vard. Pasig Ci ty lleallhl int: 441-7444 www.philhca llh.gov.ph
1. Guidelines in the proper filling-up of Claim Form Summ.ary Report is provided herein (A nnex C).
2. In cases where day 3 and /or day 7 was/ were not administered because o f confinement or death, the full package shall be paid to the health facility. These shall be supported by the applicable documents: a. Deceased: Death Certificate or Certification o f Death issued by the MHO/ CHO b. Admitted in a hospital : Certificate of Admission issued by the hospital c. Repeat exposure- Animal bite treatment record reflecting the date/s of
administration of the booster dose/s 3. Strict compliance to the "No Balance Billing Policy" for spo nsored members shall be
enforced. 4. To ensure completion of appropriate treatment, the member shall complete the treatment
in one accredited provider 5. Complete and proper filling-up of the summary claim form is advised in order to prevent
denial o r return o f claim applications. (Please re fer to annex for details) 6. To ensure efficient utilization of the reimbursements, LGUs with accredited ABP
providers are encouraged to create a trust fund for Phi!Health reimbursements that will ensure availability of a revolving fund.
All issuances that are inconsistent with the provisions of this Circular arc deemed superseded.
For informatio n and guidance.
n\' tcan1phi I health rJ W\V\V. racebnokcnm/Philllealth lliil inloli/!philhcalth.gov.ph
REGION I
(I LOCOS)
• Annex A
DEPARTMENT OF HEALTH
National Center for Disease Prevention and Control-Infectious Disease Office
National Rabies Prevention and Control Program
List of Animal Bite Treatment Centers (ABTC)
llocos Norte
17 ABTCs
Provincial Health Office, Laoag
City
Gov. Roque Ablan Sr. Memorial
Hospital, Laoag City
Contact Person iTelephone Number I
I L - .
- ~·--- ------.. -~~--' .... ............. ·-·· -· -·--·--·········--···--- . ·······-- ------·-·--··---·---·- ··-· -· .. llocos Sur Gabriela Silang General Hospital,
Tamag, Vigan City
La Union
Pangaslnan
Candon City Health Office, Candon
City
Vigan City Health Office, Vigan
City
Bacnotan District Hospital
La Union Medical Center, Agoo, La
Union
San Fernando City Health Office
llocos Training and Regional
Medica l Center, San Fernando
City
Pangasinan Provincial Hospital,
San Carlos City
Western Pangasinan District
Hospital, Alaminos City
San Carlos City Health Office
Dagupan City Health Office
Region 1 Medica l Center- no
trained personnel
i
"'!
REGION II
(CAGAYAN VALLEY)
Cagayan
Isabel a
Nueva Vizcaya
Qurino
REGION Ill
(CENTRAL LUZON)
Aurora
Ala minos City Health Office
Urdaneta District Hospital,
Urdaneta City
16ABTCs
Cagayan Valley Medical Center, Tuguegarao
City
Provincial Health Office- Cagayan Clinic,
Capit ol Cmpd., Tuguegarao City
Aparri RHU
Gonzaga RHU
Faustino Dy Memorial Hospital, llagan
San Mariano RHU, !lagan
Ramon RHU, !lagan
Southern lsabela Genera l Hospita l, Santiago
City
Sa ntiago City Health Office
Mi lagros District Hospital, Cabagan
Primo Gaffud District Hospital, Echague
Cauayan District Hospital, Cauayan City
CHO II Villaluna, Roxas
Roxas District Hospital
Provincia l Health Office, Bayombong, Nueva
Vizcaya
Quirino Provincia l Hospital, Cabarroguis,
Quirino
28ABTCs
Contact Person
I
Aurora Memorial Hospital San Luis St., Baler, Aurora
Dingalan Rural Health Unit Dingalan, Aurora
Casiguran Rural Health Unit Casiguran, Aurora
i ·t .. ....
Contact Number
Ms. Dolores E. Suril
09294S61456
Ms. Josephine S. Domingo 09209830353
Ms. Marissa M . Orcullo 09193453318
~ •W•-•-• . ...
Bat aan Bataan General Hospital, Balanga City Mahahan St. Tenejero, Ms. Josephine (04 7) 237 - 1724
Balanga City Jose . ..... _ ............. .. .................... ,_ .. , .........
Bulacan Emilio G. Perez Memorial Hospital Sto. Niflo, Hogonoy Ms. Elisa Velasco (044) 667 - 2132
Gregorio del Pilar Ditrict Hospital Bugumbayan, Bulacan, Ms. Rosario
(044) 792- 0119 Bulacan Delos Angeles
Ospital ng Lungsod ng San Jose Del Bagong Buhay I, San Jose Dr. Eve lyn 09163121214
Monte del Monte City Policarpio
San Miguel District Hospital Sta . Rita, San Miguel Ms. Gladys May {044) 678- 2070/764 -
Rueda 0130 ........ ----· ____ __ .. .... ·---- -----· ·-·-- . --· ·---·- .......... - .... .... --·-· - ·- __ ,, ......... ...... .
Bulacan Medical Center Mojon, Malolos City Ms. Corazon Cruz (044) 791-0630/662-
267S
Baliuag District Hospital Carpa Village, Sabang, Ms. Marife
(044) 766 - 2364 Baliuag Tamondong
San Jose del Monte City Health Office Poblacion San Jose Del Dr. Betzaida
(044) 691- 2584 Monte, Bulacan Banaag
Nueva Ecija ELJoson Cpd, MCH M s. Ma. Teresa
Nueva Ecija Provincial Health Office Building, Bitas, Mendoza
09177959338 Cabanatuan City
City Hall Cpd., Kapt. Pepe Ms. Carolina {044) 463 - S900/600-
Cabanatuan City Hea lth Office Subd. Phase II, Gabao 3931
Cabanatuan Clty
City Hall Cpd., Poblacion Ms. Felisa
Science City of Munoz Hea lth Center West, Science City of Marcelo
(044) 465 - 5921 Munoz
San Jose City Health Office A.O. Pascual St., San Jose M s. M arilyn
(044) 511 - 4219 City Llorando
Palayan City Health Office Caimito, Palayan City M s. Briza
09175900209 Gonza les
Pampanga M acabebe District Hospital Batasan, Macabebe Ms. Felicitas Neri (045) 921- 2875
San Luis District Hospital Sta. Lucia, San Luis Ms. Cynthia
(045) 963- 2102 Sacra
Diosdado P. Macapagal Memoria l Sta. Rita, Guagua Dr. Susa na Sicat (045) 900- 2112
Hospital
Sa n Fernando RHU I Sto. Rosario, City of San
Dr. Renely Tungol (045) 961 - 3200 Fernando
Ange les City Health Office 3rd Floor, City Hall, Pulong Dr. Hernand (045) 322- 4483 I 893-Maragul, Angeles City Tulud 3628
Tarl ac Tarlac Provincia l Health Office San Vicente, Tarlac City M s. Cecille (045) 982- 1306
Lopez - Zuasula
Zambales Pres. Ramon Magsaysay Palanginan, lba, Zambales Dr. Jean Rebultan (047) 811 - 7213 Memoria l Hospital
Sa n Marcelino District Hospital Sto. Domingo, San
Ms. Ruby Duave (047) 623 - 2302 Marce lino, Zambales
Ca ndelaria District Hospital Yamot, Candelaria,
Ms. Lilia M edina 09178874101 Zambales
3
Ospital ng Sta Cruz Poblacion North, Sta Cruz, Ms. Ma. Teresa Zambales M inima
09186975514
Olongapo City Health Office Rizal St., Olongapo City Dr. Bryan Tubban (047) 224 - 1628
REGION IV-A 48ABTCs
(CaLaBaRZon)
Laguna Santa Rosa City Health Office (CHO 1), IRizal Blvd., Brgy. Market
Area, Santa Rosa City I
i (049) 534-1021
I
JP Rizal Memorial Hospital, Brgy. Bucal, Calamba City ,(049) 834-2702
I Panlalawigang Pagamutan ng Laguna ,Gen. Luna St., San Pablo City (049) 562-2788
I I Cabuyao Rural Health Unit II, Brgy. Pula, Cabuyao (049) 531-4967
I San Pablo City Health Office Bagong Pook, (049) 562-550S
I
Laguna Provincia l Hospital, I ~· De Leon St., Sta. Cruz
1
(049) 501-1984
Lulsiana District Hospita l .Fa bricante St., Lu isiana (049) 555-4071
Majayjay Medicare Hospital Brgy Talorto r, Majayjay I ,(049) 305-4505
Nagcarlan Dist rict Hospita l F. Ba ltazar St., Nagcarlan (049) 563-1016
Gen. Cailles M emoria l Hospital , Tavera Pakil (049) 557-0215
l aguna ·-- - -1(049) 501-0359 (continued ... ) Sta. Cruz RHU I, P. Guevarra St., Sta. Cruz
'
Liliw RHU , Brgy. Pag-asa, Liliw 1(049) 563-3055
Pagsa njan RHU , Brgy. Poblacion, Pagsanjan I 1(049) 501-3183
I
I 5iniloan RHU, Brgy. Bagumbayan, Siniloan (049) 813-0204
Ca lamba CHO, (046) 545-1697 ,Brgy. Poblacion, Calamba (049) 545-1697
City
Cabuyao RHU 1 Rosario Village Sala (049) 531-1153
4
I , I
Rizal Antlpolo City Health Office !Santos St., Brgy. San Roque, [(02) 696-4097 I 697-
1Antipolo City lo362 !
~ ~---··---..;. ....
Quezon
Angono MHO ABTC
TAYTAY MHO ABTC,
JALAJALA MHO A BTC,
BINANCONAN MHO ABTC,
PILILLA MHO ABTC,
CA INTA MHO ABTC
Quezon Medical Center,
Magsaysay Memorial District Hospital,
Bondoc Peninsula District Hospital,
Claro M . Recto Memorial District Hospital
Tayabas CHO,
ALABAT IS LAND DISTRICT HOSPITAL ABTC,
MA. ELEAZA R MEML DI ST liOSP ABTC
POLILLO MEDI CARE HOSP ABTC, -
DONA MARTA MEML DIST 1/0SP ABTC
LUCENA Ct-10 ABTC
Cavite Tanza RHU, Brgy.
NAIC M edicare Hospit al
Tagaytay CHO,
!sarangay 11, Lucena City i i
p 2-2953484
I :02-658-7285 I
I ,09266-196591 i !
102-6525-113 I
02-65-11093
,02-6569505 .!
I • (042) 710-39441ocal
:527 .. -~---- ·-·· ·-·-! ····-· ' .
jLopez, Quezon
.Catanauan
Jnfanta
·Gen. Luna St., Tayabas
I ( 1/abat Island
?'agkaway an
I
I ;Polillo. DL I
:.-lliiii0/1(/ 1/,
I Brgy . Gulang-gulang ,
'Daang Amaya 1, Tanza, I
1
cavite
l ~agaytay City
;(042) 302-5354/ 302-
15437
:(042) 315-8412
:(042) 535-2882/ 535-
!2127 I 163427130092
! 0-12-3028026
0-12 309832-1
i 105-1-1 7 3820 I
0-12 3165326 I
I0-12-6tl022-15
i :(046) 437-6939
I j(046) 412-0312
I j046)413-1220iocal
134
5
Dasmariilas ABTC
Gen Emilio Aguinaldo Meml Hasp
Silang RHU ABTC
Cavite CHO ABTC
Batangas Batangas Provincial Health Office,
REGION IV-B
(MiMaRoPa) (34)
Oriental Mindoro
Batangas City Health Office
Tanauan City Health Office
Sa n Juan RHU,
Don Manuel Lopez Meml Dist Hospital
Lipa City Health Office
3
Roxas District Hasp.
Pinamalyan Distri ct Hasp.
Oriental Mindoro Prov. llosp.
Calapan City Heal th Offlce
Roxas District Hasp.
Romblon Romblon Provincia l Hospital,
Romblon District Hospital,
T -· 046)416-0095 local 142
046 8640791
:046-4142925 i
046-4310752
Kumintang lbaba, Batangas 043) 723-2916/ 723-
\city F 285
P. Burgos St., Batangas City (043) 723-3103/ 723-
2472
Tanauan City
San Juan, Batangas
\salayan, Batangas I
lnosluban, Lipa City
Leonor Daite,MD
Michelle Natividad
Adelaide Malaluan,MD
Sionella Agoncillo,RN*
Matthew Rico, MD*
Emily Jill Oaxa,RW
Basil is a Lla n to
Leonor Daite,MD
Edmund Rcloj, MD
Arlyn Dcocades,RN*
Catalina Guimban,MD
Judith Roxas, RN
1(043) 778-1001/ 778-
1466
(043) 575-4058
1043-9211842
043-7842521
9194918476/4530309
9 168900442
288-4556
9193425026
9194918476/4530309
9063222249
9209175575
6
I ' I
I I
I I
Caron RHU, Caron
Culion RHU
Puerto Princesa City Health Office
Culion Sanitarium & Gen. Hasp.
Busuanga RI-IU
Aracel i RHU
Cuyo Dist. Hasp.
Ospital ng Palawan
City Health Office
Prov. Health Office
Occidental M indoro Provincial Health Office
Mamburao RHU
San jose RHC .
Sablayan RI-IC
Occidental Mindoro Prov. Hasp.
Lubang Dist. Hasp.
REGION V 24 ABTCs
(BICOL)
Alan Guintapan, MD
Ritchel Bacsa
Charlie Tejada, MD
Armando Lagrosa II,RN
Neal Vincent Torre.M D
Aida Ereiio,RN
Lesaldeo Moses Princesa,MD
Rosalinda Losaria, MD
Maricris Saclet. RN •
Rey Lazuela, MD
Nanette Lasin, RN
Susan Zambrano,MD
Erlinda Golifardo,RN
Estela Buncag, RM
Dean Palanca, MD
Mary j oy Tianchon, RN .! . Mary Ann Navarro, MD J Pamela L. Garcia, RPA, MAN I
. .1
Eileen Grace Macabihag. RN I
Meldie Driza Soriano• Evangeline Penaflor
Meneleo Simon,MD•
Emily Mendoza,RN
Karen Solar,MD*
Amelita Girao,RN*
Venmar Sayabal
i I
- --1
I
_j
9088937202
9206209817
9208746435
9182479836
9283393419
9065556877
9068775223
9196800322
9494525771
9285217452
9183216187
9078776125
9209248517
9175877121
9276351698
9154244918
9157493517
9299716250
!MEDICAL CONTACT NUMBERS !coORDINATOR
Albay Bicol Regional Teaching and Training Hospital,
Legaspi City, Albay
Sally Macinas/Rommel 09167404763
Madrid, MD
I ;
I Josefina Belmonte Memorial District Hospital,
! Ligao City
I (o52l 837-1095
Ziga Memorial District Hospital, Tabaco City
(052) 487-5903 I - ----· . -
Camarlnes Norte i Camarines Norte Provincial Hospital, Daet
I (o54l 44o-o19o
Labo District Hospital, Labo I
I (054) 585-2551 I
Camarines Sur I Bicol Medical Center, Camarines Sur
(054) 811-7800 loca l 322 I ... .
lriga Cit y Health Office, l riga City
I Naga City Hospital, Naga City
1 (05~~72.-0464 1 Ragay District Hospital
! 0921-5344176/0928-5077307
Libmanan District Hospital
I Nabua RHU
Catanduanes : Eastern Bicol Medical center, Virac
I 0928-2890534 i
I Pandan District Hospital. Pandan
0920-7436595
I Viga District Hospital
0918-6946138 I
!I Cataingan District Hospital, Cataingan
0928-6051086/ 0920-4224799 .. . -~-. -· ----~-- - - ---
Masbate Masbate Provincia l Hospita l, Masbate City
(056) 333-2244
Ticao District Hospita l, San Jacinto
I 0918-4934071
Clave ria District Hospital
0920-8094220
!Estela Zenit, MD
T - - . Berlyn Villanueva, MD
!Ramon Echano, MD
i I
I i i
Jose Vernon Banal, MD
!Maria Lilam.M[)
09193237255
09175584996
09065709543
09065709543
09189057064
!Jose Gimenez, MD 0997202622
1 (054)299-2465
l lunining Luciano, MD 472-0559
Milfred Bayot, MD 09285077307
(054) 511-8760
[Teod;r: Porni llos, -~~- 09204590016
Monista Lacorte, MD
!Rafae l Mariano, MD
I 09207436595
( erissa Guerrero, MD
I .Jovan Lim, MD
09156284185
09204224799
-~·-· .... ·------- --- - . -
Cynth ia Llacer, MD 09184525603
Jesus Camposano 0928520875 1
I Glenn Andueza, MD 09204670321
9
I I
I I
(052) 483-0014 local 4280
Josefina Belmonte Memorial District Hospital,
Ligao City
(052) 837-1095
Ziga Memorial District Hospital, Tabaco City
I (052) 487-5903
Camarines Norte Camarines Norte Provincial Hospita l, Daet
I (054) 440-0190
1 Labo District Hospital, Labo
(054) 585-2551
Camarines Sur Bicol Medical Center, Camarines Sur
1 (054) 811-7800 local 322
I riga City Health Office, lriga City
Naga City Hospi ta l, Naga City
(054) 472-0464
Ragay District Hospita l
0921-5344176/0928-5077307
Libmanan District Hospital
Nabua RHU
Catanduanes Eastern Bico l Medical center, yirac
0928-2890534
M asbate
I Pandan District Hospita l. Pandan
0920-7436595
Viga District Hospita l
1 0918-6946138
i : Cataingan District Hospital, Cata ingan
0928-6051086/ 0920-4224799
Masbate Provincial Hospital, Masbate City
(056) 333-2244
Tlcao District Hospital, San Jacinto
0918-4934071
Claveria District Hospital
0920-8094220
Estela Zenit, M D
!Berlyn Villanueva, MD
Ramon Echano, MD
09193237255
09175584996
09065709543
jJose Vernon Banal, MD 09065709543
Maria LitamJvtl) 09189057064
Jose Gimenez, MD 0997202622
(054) 299-2465
Lunining Luciano, MD 472-0559
Milfred Bayot, M D 09285077307
(054) 511-8760
Teodora Pornillos, MD 09204590016
I
Monista Lacorte, MD
Rafae l M ariano, MD 09207436595
Nerissa Guerrero, MD 09156284185
Jovan Lim, M D 09204224799
Cynthia Llacer, MD 09184525603
Jesus Camposano 09285208751
Glenn Andueza, MD 09204670321
l)
I I I
I
Sorsogon
REGION VI
(WESTERN VISAYAS)
Aklan
Antique
Dr. Fernando Duran Memorial Hospital, I
Sorsogon City
(056) 211-3809
l rosin District Hospital, I rosin
0919-8797037
Donsol District Hospital, Donsol
0915-8492714/ 0920-1544880
Gubat District Hospital
(056) 311-1100
Sorsogon City Health Office, Sorsogon City
Vicente Peralta Mem Hasp
34 ABTCs
Rafael S. Tumbokon Mem' l Hospi tal, Ka libo, Aklan
268-5626
Arige l Sa lazar M em' l Hospital, San Jose, Antique
540-8880
Ma rlen Gapayao, MD
Ludovic Tan, MD
Joseph Chavez,MD
Franco Lagatuz, MD
Ruel Rebustillo, MD
Charlie Bandola, MD
Capiz Roxas Memorial Provincial Hospital, Arnalda Blvd. Roxas City
0918-3248004/0928-7037542
Roxas City Health Office, Bangbang St., Roxas City
62 1-0578
Iloilo Iloilo City Health Office
337-5284
Passi City Health Office
311-5046
Passi District Hospital, Passi City
311-5453
Western Visayas M edical Center, Mandurriao, Iloi lo City
32 1-2841 local 190
I loilo Provincial Hospital, Pototan
529-7498
Rep. Pedro Trona M emorial District Hospital, Guimbal
315-5172/ 512-0234
09175874592
09175874592
09201544880
09275149299
0918-6985412/ 0917-
8680633
09206096708
10
l
·'
Ramon Tablana Mem'l District Hospital, Cabatuan
522-8211
Federico Ramon Ti rador Sr, Mem' l Hospital, Janiuay
317-1319
Sara District Hospital, Sara
392-0144
Dr. Ricardo Y. Ladrido Memorial District Hospital, Lambunao
349-1578
Barotac Viejo District Hospital, Barotac Viejo
362-0300
Balasan District Hospital, Balasan
397-0169
Negros Occidental Bacolod City Health Office
434-4098
Bago City Health Office
461-0118
Cadiz City Health Office
0919-5741226
Escalante City Health Office
0920-8811150
Himamaylan City Health office
388-3504
Kabankalan City Health Office
471-3069
La Carlota City Health Office
460-2683
Sagay City Health Office
0919-3454537
Silay City Hea lth Office
495-5018
San Carlos City Health Office
0916-3124291
Tallsay City Health Office
0919-4416675
II
I • I
Guimaras
REGION VII
(CENTRAL VISAYAS)
Cebu
Negros Oriental
Sipalay City Health Office
0909-6521275
Victorias City Health Office
399-3437
Dr. Jose Locsin Mem. Prov. Hosp., Silay City
Escalante District Hospita l
454-8015
Kabankalan District Hospi tal
471-2357
Don Salvador Benidecto Mem'l Hospital, La Carlota City
460-3360
Guimaras Provincial Hospital, Jordan, Guimaras
581-3331
27 ABTCs and 3 ABCs
Provincial Health Office, Cebu Provincia l Capitol, Cebu
City
Cebu City Health Department, Cebu City
Danao District Hospital, Danao City
Minglanilla District Hospital, Minglanilla, Cebu
Lapu- Lapu City Health Office, Lapu-lapu City
Mandaue City Health Office, Mandaue City
Tuburan Rura l Health Unit, Tuburan, Cebu
Medellin Rura l Health Unit, Madellln, Cebu
Maiabuyoc District Hospita l, Malabuyoc, Cebu
Argao District Hospital Hospita l, Argao, Cebu
Bari li District Hospita l, Barili, Cebu
Toledo City Health Office, Toledo City
Bantayan District Hospital,. Bantayan, Cebu
Oslob District Hospital, Oslob, Cebu
Ricardo Maningo District Hosp' l, Camotes, Cebu
Negros Oriental Provincia l Hospital, Dumaguete City
Contact Number
032-253-9773
032- 232-6969
032-200-4482
032-490-2937
032-340-5339
032-346-0110
032-463-9007
032-436-2019
032-516-1495
032-367-7500
032-470-9026
032-322-5239
032-352-5231
032-4819985
035-225-9291
12
I .,
Dumaguete CHO, Dumaguete, City
Slato n District Hospital, Slaton, Negros Oriental
Bendoy District Hospital, Bendoy, Negros Oriental
La Libertad RHU, La Libertad, Negros Oriental
Bayawan District Hospital, Bayawan, Negros Oriental
Bais District Hospital, Bais City Negros Oriental
Siquijor Siquijor Provincial Health Office, Siquijor
Bohol
REGION VIII
(EASTERN VISA VAS)
Garcia Memorial Provincial Hospital, Talibon, Bohol
Celestino Gallares Memorial Hospital, Tagbilaran City
Emilio del Valle Memorial Hopspital, Ubay, Bohol
Private (Family Vaccine)
I 16ABTCs
• Teodoro B Galagar District Hospital,
Jagna, Bohol
• Cong. Natalia P. Castillo Sr. Memorial
Hospital, Loon, Sohal
• Carmen Memoria l hospital, Carmen,
Bohol
Tacloban City Eastern Visayas Regional Memorial Center
Tacloban City Hospital
Leyte Leyte Provincial Hospital, Pa lo, Leyte
Ormoc City Health Office
Western Leyte Provincial Hospital
Southern Leyte Salvacion M Ynlgues Memorial Hospital, Maasln
Anahawan District Hospital
Biliran Biliran Provincial Hospital, Nava l
035-225-2535
035-427-0307
035-405-3034
035-409-4020
035-531-0485
035-407-8317 I 402-3194
'035-344-2014
038-515-5081
038-411-4 868/4 869
038-518-0379/0324
,038-525-9510
038-505-9426/9170
038-2382-405
(053) 523-2809
(053) 323-3151
(053) 323-3057
255-2225/4062
381-2368/2396
500-9179
13
I • I
Samar Samar Provincial Hospital, Catbalogan, Samar
Ca lbayog City Health Office, Calbayog City
Eastern Samar Eastern Samar Provincial Hospital, Boronga n
' Oras District Hospital I
· Fel ipe Abrigo Memorial Hospital 1.__ ·-· --- -- . .
I Albino Duran Memorial Hospital
, Can-Avid District Hospita l, Can-avid
Northern Samar i Nort hern Samar Provincial Hospital, Cat arman
356-1423
209-2617/ 2790
560-9555
500-9032/9308
i REGION IX
(WESTERN
MINDANAO)
17 ABTCs Contact Person I Contact Number
I
I __ _j
Zamboanga City Zamboanga City Health Office, Petit
Barracks
Zamboanga City Medical Center, Dr.
Evangelista St., Sta. Catalina
Labuan Public Hospital, Brgy. Labuan
Zamboanga del Norte Dipolog City Hea lt h Office, Brgy.
Estaka, Dipolog City
Zamboanga del Norte (ZDN) Medical
Center, Brgy. Sicayab, Dipolog City
Dr. Jose Riza l Memoria l Hospital,
Brgy. Lawaan, Dapitan City
Sindangan District Hospita l,
Slndangan
Liloy Integrated Hospital, Liloy
Zamboanga del Sur Pagadian City Health Office
Aurora General Hospital
Margosatubig Regiona l Hospital,
Margosatubig
Zamboanga del Sur Medical Center,
Pagadian City
I I
--- ___ ., ______ _L
'o62) 991-5421
I - ·- ----!(o62l 990-4769/ 991-0573 I
1(062) 926-0259
I (065) 212-3400
:(065) 212-5080/212-5081/ fax
1212-3625
(065) 213-6421
,(062) 211-5634
I
14
I
·'
Zamboanga Sibugay Zamboanga Sibugay Provincia l
Hospital, Brgy. Sanito, lpil
Olutanga Municipal Hospital, Brgy.
Bater ia, Olutanga
Alicia Dist rict Hospital, Alicia
lsabela City Basilan General Hospita l, lsabela
City, Basilan
REGION X
(NORTHERN
MINDANAO)
lsabela City Health Office, I sa be la
City, Basilan
: 20ABTCs
Bukidnon Bukidnon Provincial Hospitai -Maramag
Bukidno n Provincial Hospitai -Malaybalay
Manalo Fortich RHU
Malaybalay City Health Office
Cagayan de Oro City Health Office
Va lencia City Health Office, Valencia, Bukidnon
Misamis Oriental Misamis Oriental Provincial Health Office
Clajavita ILHZ, Misamis Oriental
Galileo ILHZ , Misamis Oriental
Manluna ILHZ
Gingoog City Health Office
Misamis Occidental Misamis Occidental Provincial Hospital, Oroquieta City
Ozamiz City Health Office, Ozamiz Ctiy
Oroquieta City Health Office (additional)
camiguin Camiguin Provincia l Hospital
Lanao del Norte Lanao del Norte Provincial Hospital, Baroy
lligan City Health Office, lligan City
Kolambugan District Hospital, Lanao del Norte
Kapatagan District Hospital, Lanao del Norte
Cagayan de Oro City Cagayan de Oro City Health Office
-· I (062) 333-2323
15
I • I
REGION XI
(DAVAO)
Northern Mindanao Medical Center
19 ABTCs and 4 ABCs
Davao City City Health Office
Paquibate District Hospita l
Davao Medical Center
Davao del Norte Oavao Regional Hospital, Tagum City
Kapa long District Hospita l, Kapalong
Sa mal District Hospita, Samal City
Carmen District Hospital, Carmen
Panabe City Health Office
Compostela Valley M ontevista District Hospital, Montevista
Pantukan District Hospital, Pantukan
Maragusan Municipa l Hospital, Maragusan
Laac Community Hospital, Laac Compostela Valley
Davao del Sur Davao del Sur Provincia l Hospital, Dlgos City
Mal ita District Hospital, M alita
Matanao Medicare Commu nity Hospital, Matanao
Davao Oriental Davao Oriental Provincial Hospital, M ati City
REGION XI
(DAVAO)
Lupon District Hospital, Lupon
Manay Community Hospital, Manay
Cateel District Hospital, Cateel
Satellite ABCs:
Laak Community Hospital
Maragusan Community Hospita l
Panabo City Health
Bunawan District Office
19 ABTCs and 4 ABCs
Davao City 1 City ~ealth Office
16
I ..
Paquibate District Hospital
Davao Medical Center I
Davao del Norte Davao Regional Hospital, Tagum City
, Kapalong District Hospital, Kapa long I
I Samal District Hospita, Samal City
J Carmen District Hospital, Carmen
' Panabe City Health Office
Compostela Valley Montevista District Hospital, Montevista
I j Pantukan District Hospital, Pantukan
Maragusan Municipal Hospita l, Maragusan
1 Laac Community Hospital, Laac Compostela Valley I
Davao del Sur ! Davao del Sur Provincial Hospital, Digos City
Malita District Hospital, Malita
Matanao Medicare Community Hospital, Matanao
i Davao Oriental Davao Oriental Provincial Hospital, Mati City
REGION XII
(SOCCKSARGEN)
Lupon District Hospital, Lupon
[ Manay Community Hospital, Manay
I Cateel District Hospital, Cateel
Sate llite ABCs:
Laak Community Hospital
Maragusan Community Hospital
Panabo City Health
Bunawan District Office
Ill ABTCs
I ~ Cotabato Regional Medical Center, Cotabato City (064) 421-2192
Cotabato Provintial Hospital, Amas, Cotabato
South Cotabato Provincial Hospital, Koronadal
City
' Kidapawan City Health Office
0928-5078007
(083) 552-3141
(064) 288-1377
17
I • I
CAR
l Dr. Amado P. Diaz Provincial Hospital Midsayap, 0908-4676455
Cotabato
, General Santos City Hospital
Lebak Medicare Community Hospital, Lebak,
Sultan Kudarat
0919-2533901
0910-3996771
Polomoloc Rural Health Unit, Polomoloc, South {083) 225-2035
Cotabato
Tacurong City Hea lth Unit, Tacurong City
Sultan Kudarat Provincial Hospital, lsulan, Sultan
I Kudarat
Sarangani Provincial Health Office, Alabel,
Sa ranganl
8ABTCs
{083) 508-2285
Benguet Benguet Provincia l Health Office, Benguet General Hospital Compound, La Trinidad, Benguet
Apayao Apayao Provincial Hospital, Kabugao, Apayao
Sta. M arcela RHU, Santa Marcela, Apayao
A bra Abra Provincial Hospital, Bangued, Abra
lfugao lfugao Provincial Health Office Lagawe, lfugao
M ountain Province Mountain Province Provincial Health Office, Bontoc
Kalinga Ka linga Provincial Hospital, Bulanao, Tabuk City
Baguio Baguio City Health Service Office, T. Alonzo St., Baguio City
CARAGA 21 ABTCs
Agusan Del Norte Provincial11ospital Agusan del Norte, Llbertad, Butuan City
Cabadbara n District Hospital
Nasipit District Hospital
Agusan Del Sur D. 0 Plaza Memorial Hospital
Bunawan District Hospital
Surigao Del Norte Caraga Regiona l Hospital
Del Carmen Distric Hospital
I ll
I,
'
Malimono District Hospital
Pillar District Hospital
Socorro District Hospital
Siargao District Hospital
Surigao Del Sur Adela Sierra Ty Medical Center, Tandag
Bislig District Hospital, Managoy, Bislig
Hinatuan District Hospital
Lianga District Hospital
Madrid District Hospita l
Dinagat Islands Dinagat District Hospital
Alber District Hospital
Lo reto District Hospita l
Butuan City Butuan City Medical Center, Langlhan, Butuan City
Surigao City City Health Office, Surigao City
NATIONAL CAPITAL
REGION
· 21ABTCs
Referral Hospitals Research Institute for Tropical Medicine (RITM), Ala bang, Muntinlupa City
District I
District II
San Lazaro Hospital, Sta Cruz, Manila
Philippine General Hospita l, Tah Avenue, Manila
Pagamutang Bayan ng Malabon, Maya-Maya St. cor .
Dagat-Dagatan Avenue, Malabon City
Navotas Emergency & Lying-in Clin ic, M. Naval St., San
Jose, Navotas
Malinta Health Center, Brgy. Hal l, Malinta, Va lenzuela
City
Bagong Silang Health Center, Phase I, Brgy. Bagong
Si lang, Caloocan City
Marikina Health Office, Prissa Bldg., Shoe Avenue, Sto.
Nino, Marikina City
Pasig Health Office, Market Avenue., Pasig City
(02) 285-2898/ 285-2804
(02) 281-8728
(02) 445-1406
(02) 962-8206
(02) 998-5045
(02) 642-7754/ 640-2058
19
~ ,,
i ARMM
. Delfin Sa longa Health Center, Emerald Court Subd ., Sto. (02) 641-3246
Rosario, Pateros
lbayo Health Center, Natividad St., Bry. lbayo, Tipas,
Taguig City
Quezon City Employees Clinic, Quezon City Health
Department, Kalayaan Avenue, Quezon City
District Ill Makati Health Departme nt, Makati City Hall, J.P. Rizal
Avenue, Makati City
Mandaluyong Health Office, Bani Ave., Maysilo St.,
Mandaluyong City
San Juan Health Office Unit I, Municipal High School,
Narciso St., San Juan City
Main Health Office, San Juan Unit II, P. Narciso St.,
Pinaglabanan, San Juan City
. Manila Health Department, Division of Preventable
Diseases, Manila City Hall
District IV Las Pinas Health Center, Pam plana Ill , Las Pinas City
Silverio Healt h Center, Paraiiaque City
Alabang Health Center, National Road, Putatan,
Muntinlupa City
San Isidro Health Center, Domingo St., Pasay City
. \ : ; ' i• •..rt•_,....,_.;. ·;~.!~ .. ~
Maguindanao M aguindanao Provincial Hospita l
Datu Blah District Hospital
Lanao del Sur Wao District Hospital
Sulu Sulu, Provincial Health Office
Sulu Sanitarium. Jolo Sulu
Dr. Majid - 09277704 77 1
(02) 642-2462
(02) 926-4237 I 926-4201
(02)895-4001 1oca l 604/606/607
(02) 534-0163
(02) 744-0736
{02) 724-027 1
(02) 527-4941
(02) 871-3909/ 873-9145/ 872-3169
(02) 826-9712
(02) 842-2560
(02) 831-5275
20
SUMMARY
17
II 16
Ill 28
IV-A 48
I V-B 34
v 24
NCR
i 21
. =·r . ~ · .:
'1: ': . ::\ ... ·-·--·
ABC
.:.. . .'.:.:·· : ......
... : I ": ,,· .·:!
•. ""·1
CAR I 8 I .
.. ·-~.~~ :~ _ t~=c;-;!~~Ii~t";:.·~ .:~: :~~c-:·.1 VI I
I 34
VII . -·· -r----------· ; -7
i
--~-- -~~~~~;~--r:· _ ... ·:·.··-···-·: -···· 16
i J 1 I
I 3 ! ····-··-···-·--·-·-····--····-·-·-·-····1
I
I
', 1
2 1
•'
Annex C
Proper filling up Animal Bite Package Forms for Reimbursement
A. Claims Summary Report (CSR)*
1. Indicate Provider Code or Accreditation number in the space provided 2. Columns:
a. Patient's name b. Encircle the letter M if patient is member or Dis dependent c. PIN (PhiiHealth Identification Number) d. lCD code of the diagnosis e. Date of administration of the 1st dose of anti rabies vaccine (ARV) f. Date of administration of Day 3 ARV g. Date of administration of Day 7 ARV h. Date Rabies Immunoglobulin was administered i. Signature of member to confirm services were rendered
3. Authorized signatory at t he lower left portion of the form is the personnel in charge of fi lling up of PhiiHealth claims
4. Head of facil ity - MHO, CHO or Chief of Clinic Note: • Each patient or member's claim listed should have Claim Form (CF)1 att ached. If there are 7 patients listed,
there should be 7 claim form 1 attached to the CSR. • Incomplete data in CSR may resu lt in withholding of reimbursement subject to submission of Animal Bite
Treatment Record. *The CSR is a list of patients who are recipient of ABP and whose reimbursement shall be paid to the facility
B. Claim Form 2 for directly Filed Claims
All items must be properly fi lled-up · Part 1
• Item #10. Confinement period a. Date admitted - Day 0 o f treatment b. Date discharged - Day 7 of treatment e. No. of days cla imed - 1
• Item #11 e. 11. Health Care Provider Services Actual Charges PhiiHealth Benefit
e. Benefit packages - ABP P3,000 P3,000
• Item #16. Leave this blank is patient is private
Part II
For PhiiHealth use on I
• Under the Generic/ Brand name, write the immunizations and date administered. To illust rate:
PART II DRUGS AND MEDICINES Generic/ Brand Name Preparation Quantity Unit Price RIG May 3, 2012 DayO May 3, 2012 Day 3 May 6, 2012 Day 7 May 10, 2012
• In case of incomplete vaccination due to hospital admission or death of patient, write the word admitted and the name of the hospital and date of admission (in case of admission) or date of death (as the case maybe). To illustrate: a) Hospital admission of patient
PART II DRUGS AND MEDICINES
Generic/ Brand Name Preparation Quantity Unit Price RIG - May 10, 2012 Day 0 - May 10, 2012 Day 3 - Admitted; Phil. Gen. Hospital; May 11,2012
b) Repeat exposure
PART II DRUGS AND MEDICINES Generic/ Brand Name Preparation Quantity Unit Price RIG -Day 0 -
Day 3 -Day 7 -
Day 28 -Booster 1 - May 12, 2012