Republic of the Philippines

Philippines Health Insurance Corporation

Lucena Grand Terminal, Lucena City
Category: PRIVATE-EMPLOYED
NEWFILE/REFILE
Hospital/ Health Provider: SMMC Paanakan
Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
Accreditation No.: M41017565
PHILHEALTH
NUMBER

NAME OF
MEMBER

NAME OF
PATIENT

CONFINEMENT
PERIOD

08-0255476991

Romel S.
Castillo

Cael Andrey M.
Castillo

05-15-2016 TO
05-17-2016

Total No. of Claims: 1 CLAIM

Prepared By:
APRIL D . NOOL, RN
Name & Signature of Hospital Representative

Transmittal No:
Philhealth
FINAL
DIAGNOSIS
G3P3(3-0-0-3) PU
39
4/7 WEEKS AOG
VIA LMP,
CEPHALIC IN
LABOR

CLAIM
AMOUNT

P 1,550.00

Republic of the Philippines

Philippines Health Insurance Corporation
Lucena Grand Terminal, Lucena City
Category: PRIVATE-EMPLOYED
NEWFILE/REFILE
Hospital/ Health Provider: SMMC Paanakan
Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
Accreditation No.: M41017565
PHILHEALTH
NUMBER

NAME OF
MEMBER

NAME OF
PATIENT

CONFINEMENT
PERIOD

0-80254224905

ARLENE
CUASAY
VILLANUEVA

ARLENE
CUASAY
VILLANUEVA

04-17-2015 TO
04-18-2015

0-80254224905

ARLENE
CUASAY
VILLANUEVA

ASHLEY RAVEN
CUASAY
VILLANUEVA

04-17-2015 TO
04-18-2015

0-80512518153

ISABEL CAIG
BUENCILLO

ISABEL CAIG
BUENCILLO

03-19-2015 TO
03-20-2015

0-80512518153

ISABEL CAIG
BUENCILLO

QUEEN ALLYSA
CAIG
BUENCILLO

03-19-2015 TO
03-20-2015

Total No. of Claims: 4 CLAIMS

Prepared By:

Transmittal No:
Philhealth
FINAL
DIAGNOSIS
G4P4(4-0-0-4) PU
40 WEEKS AOG
VIA LMP,
CEPHALIC IN
LABOR
FULL TERM BABY
GIRL DELIVERED
VIA NSD
G3P3(3-0-0-3) PU
40 WEEKS AOG
VIA LMP,
CEPHALIC IN
LABOR
FULL TERM BABY
GIRL DELIVERED
VIA NSD

CLAIM
AMOUNT

P 8, 000.00

P 1, 550.00

P 8, 000.00

P 1, 550.00

HERLENE LANI S. NOOL, RN

Name & Signature of Hospital Representative
Republic of the Philippines
Philippines Health Insurance Corporation
Lucena Grand Terminal, Lucena City
Category: PRIVATE-EMPLOYED
NEWFILE/REFILE
Hospital/ Health Provider: SMMC Paanakan
Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
Accreditation No.: M41017565
PHILHEALTH
NUMBER

NAME OF
MEMBER

NAME OF
PATIENT

CONFINEME
NT
PERIOD

0-80511342655

RENATO
CUBILLA
BENUSA

MICHELLE
CUATON
BENUSA

03-06-2015
TO
03-07-2015

0-80511342655

RENATO
CUBILLA
BENUSA

RHEA MAE
CUATON
BENUSA

03-06-2015
TO
03-07-2015

0-80507189273

MARK ANTHONY
LAURESTA
NATAL

RAQUEL
CERVANA
NATAL

03-22-2015
TO
03-23-2015

0-80507189273

MARK ANTHONY
LAURESTA
NATAL

MARIEL
CERVANA
NATAL

03-22-2015
TO
03-23-2015

0-80253922773

JULIE
VILLALOBOS
BALANI

JULIE
VILLALOBOS
BALANI

03-08-2015
TO
03-09-2015

0-8025392277-

JULIE

PRINCE YUAN

03-08-2015

Transmittal No:

FINAL DIAGNOSIS
G2P2(2-0-0-2) PU 40
WEEKS AOG VIA
LMP, CEPHALIC IN
LABOR
FULL TERM BABY
GIRL DELIVERED VIA
NSD
G4P4(4-0-0-4) PU 41
WEEKS AOG VIA
LMP, CEPHALIC IN
LABOR
FULL TERM BABY
GIRL DELIVERED VIA
NSD
G3P3(3-0-0-3) PU 38
WEEKS AOG VIA
LMP, CEPHALIC IN
LABOR
FULL TERM BABY

Philhealth

CLAIM
AMOUNT

P 8, 000.00

P 1, 550.00

P 8, 000.00

P 1, 550.00

P 8, 000.00
P 1, 550.00

VILLALOBOS
BALANI

BALANI
SORIANO

TO
03-09-2015

BOY DELIVERED VIA

NSD

Total No. of Claims: 6 CLAIMS

Prepared By:
HERLENE LANI S. NOOL, RN
Name & Signature of Hospital Representative
Republic of the Philippines
Philippines Health Insurance Corporation
Lucena Grand Terminal, Lucena City
Category: PRIVATE-EMPLOYED
NEWFILE/REFILE
Hospital/ Health Provider: SMMC Paanakan
Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
Accreditation No.: M41017565
PHILHEALTH
NUMBER

NAME OF
MEMBER

NAME OF
PATIENT

CONFINEMENT
PERIOD

0-80255263580

ROSE-ANN
PARDO TARIM

ROSE-ANN
PARDO TARIM

05-06-2015 TO
05-08-2015

0-80255263580

ROSE-ANN
PARDO TARIM

AFYIAH TARIM

05-06-2015 TO
05-08-2015

0-80257848330

CHERRY MAY
LOPEZ
SERRANO

CHERRY MAY
LOPEZ
SERRANO

04-03-2015 TO
04-04-2015

Transmittal No:
Philhealth
FINAL
DIAGNOSIS
G3P3(3-0-0-3) PU
39 2/7 WEEKS
AOG VIA LMP,
CEPHALIC IN
LABOR
FULL TERM BABY
GIRL DELIVERED
VIA NSD
G2P2(2-0-0-2) PU
40 5/7 WEEKS
AOG VIA LMP,
CEPHALIC IN
LABOR

CLAIM
AMOUNT

P 8, 000.00

P 1, 550.00

P 8, 000.00

0-80257848330

CHERRY MAY
LOPEZ
SERRANO

KAIZER LOPEZ
SERRANO

04-03-2015 TO
04-04-2015

FULL TERM BABY

BOY DELIVERED
VIA NSD

P 1, 550.00

Total No. of Claims: 4 CLAIMS

Prepared By:
HERLENE LANI S. NOOL, RN
Name & Signature of Hospital Representative
Republic of the Philippines
Philippines Health Insurance Corporation
Lucena Grand Terminal, Lucena City
Category: PRIVATE-EMPLOYED
NEWFILE/REFILE
Hospital/ Health Provider: SMMC Paanakan
Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
Accreditation No.: M41017565
PHILHEALTH
NUMBER

NAME OF
MEMBER

NAME OF
PATIENT

CONFINEMENT
PERIOD

0-20503062667

LIEZL ALEMAN
AMOGUIS

LIEZL ALEMAN
AMOGUIS

03-15-2015 TO
03-17-2015

0-20503062667

LIEZL ALEMAN
AMOGUIS

0-0043233475-

REYNALDO

TIFFANY BLAIR
AMOGUIS
BALYOYO
ANA JANE

03-15-2015 TO
03-17-2015
03-11-2015 TO

Transmittal No:
Philhealth
FINAL
DIAGNOSIS
G3P3(3-0-0-3) PU
39 6/7 WEEKS
AOG VIA LMP,
CEPHALIC IN
LABOR
FULL TERM BABY
GIRL DELIVERED
VIA NSD
G5P5(5-0-0-5) PU

CLAIM
AMOUNT

P 8, 000.00

P 1, 550.00
P 8, 000.00

BRAZA
CORNISTA JR.

MERCADO
COTONER

03-13-2015

0-00432334755

REYNALDO
BRAZA
CORNISTA JR.

JIREH COTONER
CORNISTA

03-11-2015 TO
03-13-2015

38 WEEKS AOG
VIA LMP,
CEPHALIC IN
LABOR
FULL TERM BABY
BOY DELIVERED
VIA NSD

P 1, 550.00

Total No. of Claims: 4 CLAIMS

Prepared By:
HERLENE LANI S. NOOL, RN
Name & Signature of Hospital Representative
Republic of the Philippines
Philippines Health Insurance Corporation
Lucena Grand Terminal, Lucena City
Category: PRIVATE-EMPLOYED
NEWFILE/REFILE
Hospital/ Health Provider: SMMC Paanakan
Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
Accreditation No.: M41017565
PHILHEALTH
NUMBER

NAME OF
MEMBER

NAME OF
PATIENT

CONFINEMENT
PERIOD

0-80506945376

MARLON
MARAO
CADAHING

SHA-SHA
ABENIDO
CADAHING

04-11-2015 TO
04-12-2015

Transmittal No:
Philhealth
FINAL
DIAGNOSIS
G1P1(1-0-0-1) PU
37 5/7 WEEKS
AOG VIA LMP,
CEPHALIC IN
LABOR

CLAIM
AMOUNT

P 8, 000.00

0-80506945376

MARLON
MARAO
CADAHING

PRINCESS ELLIE
ABENIDO
CADAHING

04-11-2015 TO
04-12-2015

0-90500896743

WILFREDO
MARTINEZ
VILLANUEVA

JADICE QUEEN
SUSMERANO
VILLANUEVA

03-20-2015 TO
03-22-2015

0-90500896743

WILFREDO
MARTINEZ
VILLANUEVA

SOFIA ANICAH
SUSMERANO
VILLANUEVA

03-20-2015 TO
03-22-2015

O;Total No. of Claims: 4 \LAIMSI,

Prepared By:
HERLENE LANI S. NOOL, RN
Name & Signature of Hospital Representative

FULL TERM BABY

GIRL DELIVERED
VIA NSD
G2P2(2-0-0-2) PU
39 4/7 WEEKS
AOG VIA LMP,
CEPHALIC IN
LABOR
FULL TERM BABY
GIRL DELIVERED
VIA NSD

P 1, 550.00

P 8, 000.00

P 1, 550.00