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    One Stop Shop Request

    Uploaded by

    Andrew Marasigan
    This document is a request form for remote medical services from the Pasig City Drug Testing Laboratory. It outlines medical service packages for food and non-food industry employees that include drug tests, chest x-rays, and other tests. The form requests company information, the number of employees to be examined, preferred exam date and location, and additional requirements like a company map and employee master list. Payment for services must be made at least one week before the scheduled medical examination.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    One Stop Shop Request

    Uploaded by

    Andrew Marasigan
    43 views1 page
    This document is a request form for remote medical services from the Pasig City Drug Testing Laboratory. It outlines medical service packages for food and non-food industry employees that include drug tests, chest x-rays, and other tests. The form requests company information, the number of employees to be examined, preferred exam date and location, and additional requirements like a company map and employee master list. Payment for services must be made at least one week before the scheduled medical examination.

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    This document is a request form for remote medical services from the Pasig City Drug Testing Laboratory. It outlines medical service packages for food and non-food industry employees that include drug tests, chest x-rays, and other tests. The form requests company information, the number of employees to be examined, preferred exam date and location, and additional requirements like a company map and employee master list. Payment for services must be made at least one week before the scheduled medical examination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    43 views1 page

    One Stop Shop Request

    Uploaded by

    Andrew Marasigan
    This document is a request form for remote medical services from the Pasig City Drug Testing Laboratory. It outlines medical service packages for food and non-food industry employees that include drug tests, chest x-rays, and other tests. The form requests company information, the number of employees to be examined, preferred exam date and location, and additional requirements like a company map and employee master list. Payment for services must be made at least one week before the scheduled medical examination.

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    © All Rights Reserved
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    OFFICE OF THE ONE STOP SHOP

    PASIG CITY DRUG TESTING LABORATORY


    Pasig City Health Office
    Tel. no. 8643-1111 local 392 to 393 , Fax no. 640111
    Email address- pasig.cityhealth@gmail.com

    ONE STOP SHOP REMOTE MEDICAL SERVICES


    REQUEST FORM

    APPLICATION DATE:_____________

    Name of Company: __________________________________________________________________________________

    Address:_____________ _______________________________________________ ______________________________


    Unit/ Flr. /No. Street Subdivision
    ____________________________________________ ______________________________________________________
    BARANGAY CITY
    Contact Person/s: 1._________________________ Landline No.: _________________Cell phone no.: _______________
    2. ________________________ Landline No.: _________________Cell phone no.: _______________

    No. of Employees to be examine: __________

    (Please Check Appropriate Medical Services Needed

    Nature of Business: Food Non-Food

    NEEDED SERVICES OFFERED (CHECK APPROPRIATE CIRCLE)

    A.FOOD PACKAGES B. NON-FOOD REQUIREMENTS INDIVIDUAL PRICE


    Chest X-RAY Chest X-RAY Chest X-RAY- P120.00
    Drug Test Drug Test Drug Test- P150.00
    Fecalysis RATE: P270.00 Fecalysis- P37.00
    Urinalysis Urinalysis- P38.00
    RATE: P 300.00 Validation Fee- P50.00

    Please Note:
    NO Employment Consultation/VALIDATION FEE for those who will avail the above mentioned packages A & B only.
    Minimum Clients – 50 Persons
    Preferred Date of Examination: ___________________________ Location: _____________________________________

    Additional Requirments:
    • Google map of the company ( Pasig City Hall to Company Address via satellite)/Land mark
    • Master list of employees ( 4 copies food, for non-food 3 copies )
    • MOA (MEMORANDUM OF AGREEMENT DOWNLOADABLE)
    IMPORTANT REMINDER:
    Payment should be done atleast(1)one week ahead before the schedule of medical examination.
    For more downloadable forms refers pls go to ( https://www.pasigcity.gov.ph/ )

    Received by: ___________________________________________________ Date: _______________________________


    (PRINTED) OSS OFFICER NAME AND SIGNATURE

    For more information, please look for MISS ROSARIO ( CHATO ) GRANADINO.

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