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PhilHealth Online Access Form (POAF)

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ivankiethgalacio8
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179 views1 page

PhilHealth Online Access Form (POAF)

Uploaded by

ivankiethgalacio8
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Annex B: PhilHealth Online Access Form

(POAF)

NO. Registration Date


PHILHEALTH ONLINE ACCESS FORM
(POAF) Form No. 002

Name of Accredited Institutional Health Care Provider PhilHealth Accreditation Number

Rural Health Unit and Reproductive Health Center of San P14035643


Francisco
Business Address

Purok 3, Barangay 4, San Francisco, Agusan del Sur


User Profile
Complete Name Signature

Ian Christopher P. Napao


Position Email address Mobile No.

Staff Ivankiethgalacio8@[Link]
Approved by: Date Signed

Ed Anthony P. Lapay, RN,MD.


To be filled-out by
PhilHealth
Installation Date Regional / Branch Office Email address

Username Password

Processed by Signature Date Processed

Approved by Signature Date Signed

Institutional Confirmation
Confirmed by: Medical Director/Administrator/Authorized Representative Date Confirmed

Page 1 of 1 of Annex B

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