REPUBLIKA NG PILIPINAS (Republic of the Philippines)

TANGGAPAN NG PANGULO (Office of the President)

TANGGAPAN NG SWEEPSTAKES PANGKAWANGGAWA NG PILIPINAS (PHILIPPINE CHARITY SWEEPSTAKES OFFICE)

CHARITY ASSISTANCE DEPARTMENT

CITIZENS CHARTER Schedule of Availability of Service: Monday Friday 6:00 a.m. 5:00 p.m. Who May Avail of the Service: (per Board Resolution 272) Individuals with health and physical problems shall avail of the Individual Medical Assistance Program (IMAP) provided that she/he meets the following criteria: 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)

Patients confined in the Charity Ward are given priority.

Patients who are confined in the Pay Ward by reasons beyond their control such as:

- Emergency cases

- Non-availability of Charity Ward

- Communicable diseases which need isolation

- Intensive Care Unit cases

- Maternity with complications

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 Requirements: REQUEST FOR HOSPITALIZATION Personal Letter Request addressed to Chairman/General Manager of PCSO

Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number

Statement of account/hospital bill certified by the billing officer/credit supervisor with printed name and signature (All necessary deduction, such as Philhealth, Senior Citizen, HMOs, if

applicable, Must be reflected in the bill)

Endorsement letter from the hospital social service for service patients (for charity) Promissory Note (if discharged)

Valid ID (patient and representative)

REQUEST FOR MEDICINES AND CHEMO Personal Letter Request addressed to Chairman/General Manager of PCSO

Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number

Prescription with printed name, signature and license # of the attending physician

Official Price Quotation from the pharmacy (c/o PCSO) Original/Certified True Copy of histopath/biopsy report duly signed by pathologist with printed name and license number

Relevant laboratory test result (for medicines)

Valid ID (patient and representative)

REQUEST FOR LABORATORY/DIAGNOSTIC PROCEDURES Personal Letter Request addressed to Chairman/General Manager of PCSO

Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number

Order Form from the doctor duly signed with license number stating need for laboratory/procedure

Official Costing of the said procedure from the laboratory section department of the hospital

Valid ID (patient and representative)

REQUEST FOR IMPLANT / PROSTHESIS / WHEELCHAIR

Personal Letter Request addressed to Chairman/General Manager of PCSO

Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number

Three (3) Official Price Quotation from different suppliers

One (1) whole body picture for wheelchair request Prescription / Specifications of the implant needed

Proof of counterpart from the patient/client

Photocopy of x-ray or ct scan report for implants

Valid ID (patient and representative)

REQUEST FOR DIALYSIS/PERITONEAL DIALYSIS

Personal Letter Request addressed to Chairman/General Manager of PCSO

Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license

Endorsement/Certificate of Acceptance of PCSO guarantee letter from the hospital or dialysis center

Official Price Quotation (for hemodialysis)

Prescription of Dialysis Solutions (for peritoneal dialysis)

Valid ID (patient and representative)

REQUEST FOR HEARING AID

Personal Letter Request addressed to Chairman/General Manager of PCSO

Clinical Abstract with name, signature and license number of doctor

Audiological Evaluation signed by the Audiometrist independent from the Audiometric Center

Three (3) Official sealed Price Quotations from the different hearing aid centers / cochlear implant supplier Proof of counterpart from the patient/client

Valid ID (patient and representative)

REQUEST FOR OPERATION

Personal Letter Request addressed to Chairman/General Manager of PCSO

Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license number and PTR number

Official Price Quotation Valid ID (patient and representative)

DURATION: Hospitalization for discharge and cases needing urgent treatment

- For P100,000.00 and below within the day

Regular cases - For P100,000.00 and below four days from the date of interview

Cases above P200,000 - Five (4) days

Cases above P200,000.00 - Seven (6) days

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/ Client

Service Provider Duration of Activity (Under Normal

Circumstances)

Person-in-Charge Fees (Services are

rendered free of charge)

Forms Needed

STAGE 1: Evaluation of Application (Day 1)

1 Submit all documentary requirements.

A. Reviews requirements

under the IMAP guidelines A1. For cases with complete

documents (With appointment and New cases)

- Attaches application forms for

those with complete documents. Note: Priority lane for Senior Citizen and Person With Disability (PWD)

A2. For cases with

incomplete document and without appointment

- Provides checklist/ orients

client with needed requirement.

- Endorses cases for medical evaluation (for request of medicines, chemotherapy,

3 minutes per case

5 minutes per case

Officer-of-the-Day (OD)

Juanito Hermancio Mariquita Reyes Josephine Zafra

Jose Osorio

Not Applicable

Prescribed

documentary requirements

IMAP Application Form

Requirements checklist

Endorsement letter

Referral Letter

diagnostic and laboratory procedures, radiotherapy, implant, hearing aid and cochlear implant, maternity and psychiatric cases)

- Prepares referral for price

quotation (for laboratory, diagnostic procedures, radiotherapy, implants, hearing aids and other requests requiring official quotation)

- Schedules cases for interview

Schedule slip

2

Fill-up the application form

2 minutes per case

Volunteer

Not Applicable

3

Proceed to the waiting area and wait for your number to be called in the queuing system for interview.

Wait for the assigned SW to

be flashed in our monitor/screen

4

Interview phase proceed to the assigned SW

Interviews, assesses and

classifies request and prepares recommendation/SCSR

Issues claim slip and advise client to comeback on the specified date for the release of guarantee letter.

20 minutes per case

Social Workers (SW)

Myla Copino

Diana de Sagun Ira Salayon Ethel Lovino

Beryl Salvadora Remelyn Cuaresma

Lydia Criscel San Juan Christine Casillano

Rosa Lee Mamaradlo Mary Ann Cunanan

Amor Tanguilig Eden Razon

Enrique Cristobal

Not Applicable

IMAP Assessment

Form

Claim Slip to be given by the assigned SW upon completion of

interview

Feedback Form to be filled up by client after

interview

5

Reviews, confirms and affixes

signature in the recommendation (SCSR)

3 minutes per case

Supervisor

Marivic Llanes Maricar Santos

Leslee Deabanico Lilibeth Javier

Not Applicable

STAGE 2: PROCESSING OF GUARANTEE LETTERS (DAY 2-6)

6

- Encodes transmittal of cases for approval

- Prepares guarantee letters

(GL)

2 minutes per case

2 minutes per case

(Day 2)

Encoder

Gina Balde (Supervisor)

Elizabeth Lompot Ursula Aguilar

Bernard Romero

Not Applicable

Guarantee Letter

7

- Reviews and affix signature in

the GL

2 minutes per case

(Day 2)

Division Chief III

Herminia B. Reyes or her authorized

Not Applicable

Note: The processing time is for one client being served at one time. The time is extended when there are more clients.

representative

8

- Approves cases not more than P100,000.00

- Recommends cases more than P100,000.00

2 minutes per case

(Day 3)

OIC-Department Manager

Dr. Jose Bernardo H. Gochoco or his authorized representative

Not Applicable

9

- Approves cases not more than

P200,000.00

2 minutes per case

(Day 4)

Asst. General Manger

Not Applicable

10 - Approves cases more than P200,000.00

2 minutes per case

(Day 6)

General

Manager/Chairperson

Not Applicable

11

- Receives and data bank approved IMAP cases

2 minutes per case

(Day 4 for cases P200,000.00 and below)

(Day 7 for more than

P200,000.00 upon approval of authorized signatory

Releasing Section

Aida Tizon

(Supervisor)

Not Applicable

Releasing of Guarantee Letters

Step Applicant/Client Service Provider Duration of Activity (Under Normal Circumstances)

Person-in-Charge Fees Forms Needed

1

Submits claim slip

Accepts and reviews claim slip

1 minute per case

Releasing Section

Aida Tizon

Nancy Filart Florida Dela Torre

Allan Domingo Ronald Magada

Rommel Azucena

Not Applicable

Claim Slip

2

Wait while the guarantee letters are being retrieved/located.

- Locates and retrieves

approved guarantee letters.

- Dry-seal the approved guarantee letters

- If the guarantee letters are not yet available, inform the client that it is not yet available.

6 minutes per case

Not Applicable

3

When the patient name is called, present valid ID Receive the approved guarantee letters

- Validates the identity of the

claimant through the presented ID and records submitted during the interview.

- Releases approved guarantee letters

3 minutes per case

Not Applicable

END OF TRANSACTION

Note: The processing time is for one client being served at one time. The time is extended when there are more clients.

JOSE BERNARDO H. GOCHOCO, JR.,M.D.

OIC- Manager, Charity Assistance Department