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    MDR 182506471770

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    ccabuga230000001838

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    © All Rights Reserved
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    MDR 182506471770

    Uploaded by

    ccabuga230000001838
    6 views1 page

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    MDR_182506471770

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    6 views1 page

    MDR 182506471770

    Uploaded by

    ccabuga230000001838

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Republic of the Philippines

    PHILIPPINE HEALTH INSURANCE CORPORATION


    Corporate Action Center Hotline - (02) 441-7442
    www.philhealth.gov.ph

    MEMBER DATA RECORD


    MEMBER BASIC INFORMATION
    PhilHealth Identification Number (PIN) : 18-250647177-0 PhilSys Number :
    Member Category : DIRECT CONTRIBUTOR - SELF
    Sub-Category EARNING INDIVIDUAL - GROUP NHTS Coverage : N/A
    ENROLLMENT SCHEME Validity Period : N/A - N/A

    CABUGA, CZAR RYAN SULAPAS


    QUIRINO STREET TAYAGA (POB. EAST), CLAVER SURIGAO DEL NORTE

    Foreign Address : N/A Sex : MALE


    Date of Birth : 05/21/2004
    Place of Birth : SURIGAO CITY, SURIGAO DEL
    NORTE
    Contact No. (Foreign) : N/A Civil Status : SINGLE
    (Local) : +639635583720 Tax Identification Number :

    ENTITY INFORMATION
    PhilHealth Number (PEN/POGN) : 316000035487
    Name of Employer/Organized Group : DEPARTMENT OF HEALTH-DAVAO CENTER FOR HEALTH DEVELOPMENT
    hidden text
    Business Address : DOH COMPOUND JP LAUREL BAJADA, POB. B. DISTRICT, DAVAO CITY DAVAO DEL SUR
    hidden text
    Telephone Number : 2274073 Employment Status :
    Tax Identification Number : N/A Date : N/A

    DEPENDENT INFORMATION
    PIN Surname Given Name Middle Name Sex Relation Date of Birth
    *** NOTHING FOLLOWS ***

    MICHAEL JIBSON C. HERNANDEZ


    REGIONAL VICE PRESIDENT
    PRO CARAGA Butuan City

    Paalala: Basahin ang nilalaman ng MDR. Kung may kulang o mali, ibalik agad upang maiwasto. Ingatan ang orihinal na kopya at huwag ibigay kahit kanino. Kung
    sakaling gagamit at makikinabang ng benepisyo, magbigay ng kopya sa ospital. (Reminder: Read the contents of the MDR. Should there be any data discrepancies,
    return it back to amend or rectify the error. Take good care of MDR and do not hand it over to anybody. Provide photocopy to hospital in case of confinement and
    availment of benefits.)
    This is a Member Portal System generated report. Signature is not required.
    Oct 12, 2024 10:34 PM

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