REQUEST FOR LABORATORY/DIAGNOSTICS PROCEDURES

FINANCIAL ASSISTANCE

PROCESSING OF REQUESTS FOR INDIVIDUAL MEDICAL ASSISTANCE PROGRAM (IMAP)Office/Department in Charge: Fund Allocation DepartmentLocation: PCSO-Lung Center of the Philippines OfficeSchedule of availability of service: Mondays to Fridays 6:00 AM - 5:00PMWho May Avail of the Service: (per Board Resolution 272)All disadvantaged individuals with health and physical problem shall avail of the Individual Medical Assistance Program (IMAP) provided that she/he meets the following criteria:1. Poverty Threshold of P19,345.00 (urban) and P16,508.00 (rural) per person per year for food and non-food items (as per National Statistics Coordination Board)2. Patients confined in the Charity Ward3. Patients who are confined in the Pay Ward by reasons beyond their control such as:

- Emergency cases- Non-availabilty of Charity Ward- Communicable diseases which need isolation- Intensive Care Unit cases- Maternity with complications

4. Out patients who are in need of chemo, post operative medication, OR needs, antibiotics, laboratory and diagnostics procedures or those patients whose illness does not need confinement.What are the initial requirements:What are the initial requirements:REQUEST FOR HOSPITALIZATION1. Personal Letter Request addressed to Chairman/General Manager of PCSO2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license & PTR #3. Statement of account/hospital bill certified by the billing officer/credit supervisor with printed name and signature4. Endorsement letter from the hospital social service patients; or from the Credit and Collection Officer for pay patients5. Social Case Study Report from Local Government Unit (optional)6. Promissory Note (if discharged)7. Valid ID (patient and representative)

REQUEST FOR MEDICINES AND CHEMO1. Personal Letter Rquest addressed to Chairman/General Manager of PCSO2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license & PTR #3. Prescription with printed name, signature and license # of the attending physician4. Official Price Quotation from the pharmacy (c/o PCSO)5. Social Case Study Report from Local Government Unit (optional)6. Original/Certified True Copy of histopath/biography report duly signed by pathologist with printed name and license/PTR #7. Relevant laboratory test results (e.g. Pathology Report)8.Valid ID (patient and representative)

REQUEST FOR LABORATORY/DIAGNOSTICS PROCEDURES 1. Personal Letter Request addressed to Chairman/General Manager of PCSO2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with the license & PTR #3. Order form from the doctor duly signed with license number stating need for procedure4. Official Costing of the said procedure from the laboratory section department of the hospital

Case from Unit

5. Social Case Study Report from Local Government Unit (optional)6. Valid ID (patient and representative)

REQUEST FOR IMPLANT/PROSTHESIS/WHEELCHAIR1. Personal Letter Request addressed to Chairman/General Manager of PCSO2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license & PTR #3. Three (3) Official Price Quotation from different suppliers4. One (1) whole body picture for the wheelchair request5. Social Case Study Report from the Local Government Unit (optional)6. Prescription/Specifications of the implant needed7. Proof of counterpart from the patient/client8. Photocopy of x-ray report for implants9. Valid ID (patient and representative)

REQUEST FOR DIALYSIS1. Personal Letter Request addressed to Chairman/General Manager of PCSO2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license & PTR #3. Endorsement/Certificate of Acceptance of PCSO guarantee letter from the hospital or dialysis center4. Official Price Quotation of dialysis5. Social Case Study Report from Local Government Unit (optional)5. Social Study Report Local Government (optional)6. Relevant laboratory result7. Valid ID (patient and representative)

REQUEST FOR HEARING AID1. Personal Letter Request addressed to Chairman/General Manager of PCSO2. Audiological Evaluation signed by the Audiometrist independent from the Audiometric Center 3. Three (3) Official sealed Price Quotations from the different hearing aid centers / cochlear implant supplier4. Social Case Study Report from Local Government Unit (optional)5. Proof of counterpart from the patient/client6. Valid ID

REQUEST FOR OPERATION1. Personal Letter Request addressed to Chairman/General Manager of PCSO2. Original/Certified True Copy of the Udated Clinical Abstract signed by the doctor with license number and PTR number3. Official Price Quotation4. Social Case Study Report from Local Government Unit (optional)5. Valid ID (patient and representative)

cases for interview Schedule Slip

Duration:Hospitalization for discharge and cases needing urgent treatment* For P50,000.00 and below - within the dayRegular Cases* For P50,000.00 and below-four days from the date of interviewCases above P50,000* Six (6) days (c/o PCSO Main Office-PICC)Filing of Application for peritoneal dialysis/hemodialysis/post operative - every 2 months from the date of the last released of Guarantee Letter (GL)

How to Avail of the Service:STEP APPLICANT/ SERVICE DURATION OF ACTIVITY UNDER PERSON IN FEES FORM

CLIENT PROVIDER NORMAL CIRCUMSTANCES CHARGESTAGE 1: Evaluation of Application (Day 1)

1 Submits all documentary requirements A. Reviews requirements under the Officer-of-the-Day (OD) None Prescribed IMAP guidelines documentary

requirements A1. For cases with complete documents (with appointment and

new cases

- Attaches application forms for those with 3 minutes per case IMAP Application complete documents. Form

Note: Priority lane for Senior Citizen and Person With Disability (PWD)

A2. For cases with incomplete documents and without appointment

-Provides checklist/orients client with Requirements needed requirement. checklist-Endorses cases for medical evaluation (for request of medicines, chemotherapy, Endorsement Letter diagnostic and laboratory procedures, radiotherapy, implant, hearing aid and 5 minutes per case cochlear implant, maternity and psychiatric cases)-Prepares referral for price quotation (for Referral Letter medicines and chemodrugs)-Schedules cases-Schedules for interview Schedule Slip

6 2 None Guarantee

2 Fills-up the application form and waits -Validation thru presented ID/authorization 2 minutes per case Photographer Nonefor the number to be called for the letterpicture-taking -Picture taking of patient or representative

-Data-banking of all captured information (picture)

3 Proceeds to the waiting area and wait Waits for the assigned Social Workerfor the number to be called in the to be flashed in the monitor/screenqueuing system for interview

4 Interview phase - proceeds to the -Interviews, assesses and classifies 20 minutes per case Social Worker None IMAPassigned Social Worker request and prepares recommendation/ Assessment Form

Social Case Study Report (SCSR)

-Issues claim slip and advises client to Claim Slip come back on the specified date for the release of guarantee letter

5 -Reviews, confirms, and affixes signtaure in 3 minutes per case Supervisor None the recommendation (SCSR)

STAGE 2 : Processing of Guarantee Letters (Day 2-6)6 -Encodes transmiEncodes ttal of cases for approvaltransmittal of cases for approval 2 minutes pminutes per er case Encoder None Guarantee Lettercase Encoder Letter

-Prepares guarantee letters (GL) 2 minutes per case (Day 2) Supervisor7 -Reviews and affixes signature in the GL 2 minutes per case (Day 2) Division Chief or None

her authorized representative

8 -Approves cases not more than P50,000.00 2 minutes per case (Day 3) Department Manager or Nonehis authorized

-Recommends cases more than P50,000.00 representative9 -Approves cases more than P50,000.00 but 2 minutes per case (Day 4-5) Asst. General Manager/ None

within the prescribed authority General Manager/*Cases transmitted to the PICC for Chairperson approval of the authorized signatory

10 -Receives and data bank approved IMAP 2 minutes per case Releasing Section None cases (Day 4-for cases P50,000.00 and Supervisor

below)(Day 6-for more than P50,000 upon

approval of authorized signatory)

Releasing of Guarantee Letters1 Submits claim slip -Accepts and reviews claim slip 1 minute per case None Claim Slip

2 Waits while the guarantee letter is -Locates and retrieves approved 6 minutes per case Nonebeing retrieved/located guarantee letters

-Dry-seals the approved guarantee letter

-If the guarantee letters are not yet Releasing Section Staff available, informs the client that is not yet available

3 When the patient name is called, -Validates the identity of the claimant 3 minutes per case Nonepresent valid ID through the presented ID and records

submitted during the interview

-Releases approved guarantee letterNote: The processing time is for one client being served at one time . The time is extended when there are more clients.

CERTIFIED CORRECT:

(Sgd.)LARRY R. CEDRO, DMDOIC-Manager

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