Rl!publlc of tile Plllllpp/ues PHILIPPINE HEALTH INSURANCE CORPORATION

Citystatc Cchti·c lluiidihg. 709 Silnw Bouh!Vard, Pnsig City llealthline 441-7444 www.philheuhh.gnv.ph

'I

June 20, 2012

PHILHEALTH CIRCULAR No.~s. 2012

-R.4 TO ALL PHILHEALTH MEMBERS, ACCREDITED PROVIDERS

PHILHEALTH REGIONAL OFFICES (PROs) AND ALL OTHERS CONCERNED

SUBJECT: Supplemental Guidelines to PhilHealth Circular 15 s . 2012 Re: PhilHealth for Animal Bite Package (Rabies P ost-exposure Prophylaxis)

Tn order to facilitate implementation of Animal Bite Package (ABP) and hasten participation of interested providers o f this package, the following additional guidelines shall be followed:

A. Provider Engagement 1. l'o r CY 2012, in lieu of the Certificate of Recognition as an .Animal Bite Treatment Center

o r Animal Bite Center from the DOH, all ABTCs and ABCs found in Annex A, a ligt of facilities capable of managing animal bites as certified by the DOH-NCDPC, shall be eligible to participate as providers for the ABP. These facilities are given until July 31, 20 12 to submit the provider's data record and signed PC fo r HCP in order to receive reimbursement.

2 . Submission o f the Certificate o f Recognition from the DOH as an ABTC/ ABC shall follow upo n issuance by said DOH office / s or upon renewal o f participatio n in the Program, whichever co mes firs t.

3. H CPs with intention to participate shall usc the Perfo rmance Commitment (PC) fo r Hcnlth Care Providers (HCP) attached to PhiiHcalth Circular 13 s. 2012.

4. 1\ BP provider which submitted provider's data reco rd (PDR) and signed P C o n o r before July 31,2012 shall be eligible fo r reimbursement beginning !\:lay 3, 2012. This means that treatment provided to Phi\Health members starting May 3, 2012 will be retroactively computed and reimbursed .

5. PDR and signed PC submitted after July 31, 2012, shall render the provider eligible for reimbursement of claims for comple ted treatment beginning on the date it complied with the requirements as stated .in l)hi\Health Circular 13 s. 2012. Claims filed for comple ted treatment prior to the date of co mpliance will NOT be reimbursed .

() . Direct ft.le from patients from May 3, 2012 may be reimbursed provided that the claims arc flied within 60 days from completion o f day 7 trentment or in cases mentio ned in U.1 of the circular, in any o f the r\TITCs in the list.

7. Fo r direc tly ftled claims, the beneficiary shall submit claim form 2 and a certjfied true copy of the completely filled -out Animal Bite Treatment Record.

8. 1\ll THCPs eligible as provider o f 1\ BP shall put a signage fo llowing the attached design and technical specifications. (Annex B)

h:amphilhealth

Republic of tile Philippines PHILIPPINE HEALTH INSURANCE CORPORATION

B. Benefits Availmeot

Citystale Ct:nu·t: Building, 709 Shaw Boult:vard. Pasig Ci ty lleallhl int: 441-7444 www.philhca llh.gov.ph

1. Guidelines in the proper filling-up of Claim Form Summ.ary Report is provided herein (A nnex C).

2. In cases where day 3 and /or day 7 was/ were not administered because o f confinement or death, the full package shall be paid to the health facility. These shall be supported by the applicable documents: a. Deceased: Death Certificate or Certification o f Death issued by the MHO/ CHO b. Admitted in a hospital : Certificate of Admission issued by the hospital c. Repeat exposure- Animal bite treatment record reflecting the date/s of

administration of the booster dose/s 3. Strict compliance to the "No Balance Billing Policy" for spo nsored members shall be

enforced. 4. To ensure completion of appropriate treatment, the member shall complete the treatment

in one accredited provider 5. Complete and proper filling-up of the summary claim form is advised in order to prevent

denial o r return o f claim applications. (Please re fer to annex for details) 6. To ensure efficient utilization of the reimbursements, LGUs with accredited ABP

providers are encouraged to create a trust fund for Phi!Health reimbursements that will ensure availability of a revolving fund.

All issuances that are inconsistent with the provisions of this Circular arc deemed superseded.

For informatio n and guidance.

n\' tcan1phi I health rJ W\V\V. racebnokcnm/Philllealth lliil inloli/!philhcalth.gov.ph

REGION I

(I LOCOS)

• Annex A

DEPARTMENT OF HEALTH

National Center for Disease Prevention and Control-Infectious Disease Office

National Rabies Prevention and Control Program

List of Animal Bite Treatment Centers (ABTC)

llocos Norte

17 ABTCs

Provincial Health Office, Laoag

City

Gov. Roque Ablan Sr. Memorial

Hospital, Laoag City

Contact Person iTelephone Number I

I L - .

- ~·--- ------.. -~~--' .... ............. ·-·· -· -·--·--·········--···--- . ·······-- ------·-·--··---·---·- ··-· -· .. llocos Sur Gabriela Silang General Hospital,

Tamag, Vigan City

La Union

Pangaslnan

Candon City Health Office, Candon

City

Vigan City Health Office, Vigan

City

Bacnotan District Hospital

La Union Medical Center, Agoo, La

Union

San Fernando City Health Office

llocos Training and Regional

Medica l Center, San Fernando

City

Pangasinan Provincial Hospital,

San Carlos City

Western Pangasinan District

Hospital, Alaminos City

San Carlos City Health Office

Dagupan City Health Office

Region 1 Medica l Center- no

trained personnel

i

"'!

REGION II

(CAGAYAN VALLEY)

Cagayan

Isabel a

Nueva Vizcaya

Qurino

REGION Ill

(CENTRAL LUZON)

Aurora

Ala minos City Health Office

Urdaneta District Hospital,

Urdaneta City

16ABTCs

Cagayan Valley Medical Center, Tuguegarao

City

Provincial Health Office- Cagayan Clinic,

Capit ol Cmpd., Tuguegarao City

Aparri RHU

Gonzaga RHU

Faustino Dy Memorial Hospital, llagan

San Mariano RHU, !lagan

Ramon RHU, !lagan

Southern lsabela Genera l Hospita l, Santiago

City

Sa ntiago City Health Office

Mi lagros District Hospital, Cabagan

Primo Gaffud District Hospital, Echague

Cauayan District Hospital, Cauayan City

CHO II Villaluna, Roxas

Roxas District Hospital

Provincia l Health Office, Bayombong, Nueva

Vizcaya

Quirino Provincia l Hospital, Cabarroguis,

Quirino

28ABTCs

Contact Person

I

Aurora Memorial Hospital San Luis St., Baler, Aurora

Dingalan Rural Health Unit Dingalan, Aurora

Casiguran Rural Health Unit Casiguran, Aurora

i ·t .. ....

Contact Number

Ms. Dolores E. Suril

09294S61456

Ms. Josephine S. Domingo 09209830353

Ms. Marissa M . Orcullo 09193453318

~ •W•-•-• . ...

Bat aan Bataan General Hospital, Balanga City Mahahan St. Tenejero, Ms. Josephine (04 7) 237 - 1724

Balanga City Jose . ..... _ ............. .. .................... ,_ .. , .........

Bulacan Emilio G. Perez Memorial Hospital Sto. Niflo, Hogonoy Ms. Elisa Velasco (044) 667 - 2132

Gregorio del Pilar Ditrict Hospital Bugumbayan, Bulacan, Ms. Rosario

(044) 792- 0119 Bulacan Delos Angeles

Ospital ng Lungsod ng San Jose Del Bagong Buhay I, San Jose Dr. Eve lyn 09163121214

Monte del Monte City Policarpio

San Miguel District Hospital Sta . Rita, San Miguel Ms. Gladys May {044) 678- 2070/764 -

Rueda 0130 ........ ----· ____ __ .. .... ·---- -----· ·-·-- . --· ·---·- .......... - .... .... --·-· - ·- __ ,, ......... ...... .

Bulacan Medical Center Mojon, Malolos City Ms. Corazon Cruz (044) 791-0630/662-

267S

Baliuag District Hospital Carpa Village, Sabang, Ms. Marife

(044) 766 - 2364 Baliuag Tamondong

San Jose del Monte City Health Office Poblacion San Jose Del Dr. Betzaida

(044) 691- 2584 Monte, Bulacan Banaag

Nueva Ecija ELJoson Cpd, MCH M s. Ma. Teresa

Nueva Ecija Provincial Health Office Building, Bitas, Mendoza

09177959338 Cabanatuan City

City Hall Cpd., Kapt. Pepe Ms. Carolina {044) 463 - S900/600-

Cabanatuan City Hea lth Office Subd. Phase II, Gabao 3931

Cabanatuan Clty

City Hall Cpd., Poblacion Ms. Felisa

Science City of Munoz Hea lth Center West, Science City of Marcelo

(044) 465 - 5921 Munoz

San Jose City Health Office A.O. Pascual St., San Jose M s. M arilyn

(044) 511 - 4219 City Llorando

Palayan City Health Office Caimito, Palayan City M s. Briza

09175900209 Gonza les

Pampanga M acabebe District Hospital Batasan, Macabebe Ms. Felicitas Neri (045) 921- 2875

San Luis District Hospital Sta. Lucia, San Luis Ms. Cynthia

(045) 963- 2102 Sacra

Diosdado P. Macapagal Memoria l Sta. Rita, Guagua Dr. Susa na Sicat (045) 900- 2112

Hospital

Sa n Fernando RHU I Sto. Rosario, City of San

Dr. Renely Tungol (045) 961 - 3200 Fernando

Ange les City Health Office 3rd Floor, City Hall, Pulong Dr. Hernand (045) 322- 4483 I 893-Maragul, Angeles City Tulud 3628

Tarl ac Tarlac Provincia l Health Office San Vicente, Tarlac City M s. Cecille (045) 982- 1306

Lopez - Zuasula

Zambales Pres. Ramon Magsaysay Palanginan, lba, Zambales Dr. Jean Rebultan (047) 811 - 7213 Memoria l Hospital

Sa n Marcelino District Hospital Sto. Domingo, San

Ms. Ruby Duave (047) 623 - 2302 Marce lino, Zambales

Ca ndelaria District Hospital Yamot, Candelaria,

Ms. Lilia M edina 09178874101 Zambales

3

Ospital ng Sta Cruz Poblacion North, Sta Cruz, Ms. Ma. Teresa Zambales M inima

09186975514

Olongapo City Health Office Rizal St., Olongapo City Dr. Bryan Tubban (047) 224 - 1628

REGION IV-A 48ABTCs

(CaLaBaRZon)

Laguna Santa Rosa City Health Office (CHO 1), IRizal Blvd., Brgy. Market

Area, Santa Rosa City I

i (049) 534-1021

I

JP Rizal Memorial Hospital, Brgy. Bucal, Calamba City ,(049) 834-2702

I Panlalawigang Pagamutan ng Laguna ,Gen. Luna St., San Pablo City (049) 562-2788

I I Cabuyao Rural Health Unit II, Brgy. Pula, Cabuyao (049) 531-4967

I San Pablo City Health Office Bagong Pook, (049) 562-550S

I

Laguna Provincia l Hospital, I ~· De Leon St., Sta. Cruz

1

(049) 501-1984

Lulsiana District Hospita l .Fa bricante St., Lu isiana (049) 555-4071

Majayjay Medicare Hospital Brgy Talorto r, Majayjay I ,(049) 305-4505

Nagcarlan Dist rict Hospita l F. Ba ltazar St., Nagcarlan (049) 563-1016

Gen. Cailles M emoria l Hospital , Tavera Pakil (049) 557-0215

l aguna ·-- - -1(049) 501-0359 (continued ... ) Sta. Cruz RHU I, P. Guevarra St., Sta. Cruz

'

Liliw RHU , Brgy. Pag-asa, Liliw 1(049) 563-3055

Pagsa njan RHU , Brgy. Poblacion, Pagsanjan I 1(049) 501-3183

I

I 5iniloan RHU, Brgy. Bagumbayan, Siniloan (049) 813-0204

Ca lamba CHO, (046) 545-1697 ,Brgy. Poblacion, Calamba (049) 545-1697

City

Cabuyao RHU 1 Rosario Village Sala (049) 531-1153

4

I , I

Rizal Antlpolo City Health Office !Santos St., Brgy. San Roque, [(02) 696-4097 I 697-

1Antipolo City lo362 !

~ ~---··---..;. ....

Quezon

Angono MHO ABTC

TAYTAY MHO ABTC,

JALAJALA MHO A BTC,

BINANCONAN MHO ABTC,

PILILLA MHO ABTC,

CA INTA MHO ABTC

Quezon Medical Center,

Magsaysay Memorial District Hospital,

Bondoc Peninsula District Hospital,

Claro M . Recto Memorial District Hospital

Tayabas CHO,

ALABAT IS LAND DISTRICT HOSPITAL ABTC,

MA. ELEAZA R MEML DI ST liOSP ABTC

POLILLO MEDI CARE HOSP ABTC, -

DONA MARTA MEML DIST 1/0SP ABTC

LUCENA Ct-10 ABTC

Cavite Tanza RHU, Brgy.

NAIC M edicare Hospit al

Tagaytay CHO,

!sarangay 11, Lucena City i i

p 2-2953484

I :02-658-7285 I

I ,09266-196591 i !

102-6525-113 I

02-65-11093

,02-6569505 .!

I • (042) 710-39441ocal

:527 .. -~---- ·-·· ·-·-! ····-· ' .

jLopez, Quezon

.Catanauan

Jnfanta

·Gen. Luna St., Tayabas

I ( 1/abat Island

?'agkaway an

I

I ;Polillo. DL I

:.-lliiii0/1(/ 1/,

I Brgy . Gulang-gulang ,

'Daang Amaya 1, Tanza, I

1

cavite

l ~agaytay City

;(042) 302-5354/ 302-

15437

:(042) 315-8412

:(042) 535-2882/ 535-

!2127 I 163427130092

! 0-12-3028026

0-12 309832-1

i 105-1-1 7 3820 I

0-12 3165326 I

I0-12-6tl022-15

i :(046) 437-6939

I j(046) 412-0312

I j046)413-1220iocal

134

5

Dasmariilas ABTC

Gen Emilio Aguinaldo Meml Hasp

Silang RHU ABTC

Cavite CHO ABTC

Batangas Batangas Provincial Health Office,

REGION IV-B

(MiMaRoPa) (34)

Oriental Mindoro

Batangas City Health Office

Tanauan City Health Office

Sa n Juan RHU,

Don Manuel Lopez Meml Dist Hospital

Lipa City Health Office

3

Roxas District Hasp.

Pinamalyan Distri ct Hasp.

Oriental Mindoro Prov. llosp.

Calapan City Heal th Offlce

Roxas District Hasp.

Romblon Romblon Provincia l Hospital,

Romblon District Hospital,

T -· 046)416-0095 local 142

046 8640791

:046-4142925 i

046-4310752

Kumintang lbaba, Batangas 043) 723-2916/ 723-

\city F 285

P. Burgos St., Batangas City (043) 723-3103/ 723-

2472

Tanauan City

San Juan, Batangas

\salayan, Batangas I

lnosluban, Lipa City

Leonor Daite,MD

Michelle Natividad

Adelaide Malaluan,MD

Sionella Agoncillo,RN*

Matthew Rico, MD*

Emily Jill Oaxa,RW

Basil is a Lla n to

Leonor Daite,MD

Edmund Rcloj, MD

Arlyn Dcocades,RN*

Catalina Guimban,MD

Judith Roxas, RN

1(043) 778-1001/ 778-

1466

(043) 575-4058

1043-9211842

043-7842521

9194918476/4530309

9 168900442

288-4556

9193425026

9194918476/4530309

9063222249

9209175575

6

I ' I

I I

I I

Caron RHU, Caron

Culion RHU

Puerto Princesa City Health Office

Culion Sanitarium & Gen. Hasp.

Busuanga RI-IU

Aracel i RHU

Cuyo Dist. Hasp.

Ospital ng Palawan

City Health Office

Prov. Health Office

Occidental M indoro Provincial Health Office

Mamburao RHU

San jose RHC .

Sablayan RI-IC

Occidental Mindoro Prov. Hasp.

Lubang Dist. Hasp.

REGION V 24 ABTCs

(BICOL)

Alan Guintapan, MD

Ritchel Bacsa

Charlie Tejada, MD

Armando Lagrosa II,RN

Neal Vincent Torre.M D

Aida Ereiio,RN

Lesaldeo Moses Princesa,MD

Rosalinda Losaria, MD

Maricris Saclet. RN •

Rey Lazuela, MD

Nanette Lasin, RN

Susan Zambrano,MD

Erlinda Golifardo,RN

Estela Buncag, RM

Dean Palanca, MD

Mary j oy Tianchon, RN .! . Mary Ann Navarro, MD J Pamela L. Garcia, RPA, MAN I

. .1

Eileen Grace Macabihag. RN I

Meldie Driza Soriano• Evangeline Penaflor

Meneleo Simon,MD•

Emily Mendoza,RN

Karen Solar,MD*

Amelita Girao,RN*

Venmar Sayabal

i I

- --1

I

_j

9088937202

9206209817

9208746435

9182479836

9283393419

9065556877

9068775223

9196800322

9494525771

9285217452

9183216187

9078776125

9209248517

9175877121

9276351698

9154244918

9157493517

9299716250

!MEDICAL CONTACT NUMBERS !coORDINATOR

Albay Bicol Regional Teaching and Training Hospital,

Legaspi City, Albay

Sally Macinas/Rommel 09167404763

Madrid, MD

I ;

I Josefina Belmonte Memorial District Hospital,

! Ligao City

I (o52l 837-1095

Ziga Memorial District Hospital, Tabaco City

(052) 487-5903 I - ----· . -

Camarlnes Norte i Camarines Norte Provincial Hospital, Daet

I (o54l 44o-o19o

Labo District Hospital, Labo I

I (054) 585-2551 I

Camarines Sur I Bicol Medical Center, Camarines Sur

(054) 811-7800 loca l 322 I ... .

lriga Cit y Health Office, l riga City

I Naga City Hospital, Naga City

1 (05~~72.-0464 1 Ragay District Hospital

! 0921-5344176/0928-5077307

Libmanan District Hospital

I Nabua RHU

Catanduanes : Eastern Bicol Medical center, Virac

I 0928-2890534 i

I Pandan District Hospital. Pandan

0920-7436595

I Viga District Hospital

0918-6946138 I

!I Cataingan District Hospital, Cataingan

0928-6051086/ 0920-4224799 .. . -~-. -· ----~-- - - ---

Masbate Masbate Provincia l Hospita l, Masbate City

(056) 333-2244

Ticao District Hospita l, San Jacinto

I 0918-4934071

Clave ria District Hospital

0920-8094220

!Estela Zenit, MD

T - - . Berlyn Villanueva, MD

!Ramon Echano, MD

i I

I i i

Jose Vernon Banal, MD

!Maria Lilam.M[)

09193237255

09175584996

09065709543

09065709543

09189057064

!Jose Gimenez, MD 0997202622

1 (054)299-2465

l lunining Luciano, MD 472-0559

Milfred Bayot, MD 09285077307

(054) 511-8760

[Teod;r: Porni llos, -~~- 09204590016

Monista Lacorte, MD

!Rafae l Mariano, MD

I 09207436595

( erissa Guerrero, MD

I .Jovan Lim, MD

09156284185

09204224799

-~·-· .... ·------- --- - . -

Cynth ia Llacer, MD 09184525603

Jesus Camposano 0928520875 1

I Glenn Andueza, MD 09204670321

9

I I

I I

(052) 483-0014 local 4280

Josefina Belmonte Memorial District Hospital,

Ligao City

(052) 837-1095

Ziga Memorial District Hospital, Tabaco City

I (052) 487-5903

Camarines Norte Camarines Norte Provincial Hospita l, Daet

I (054) 440-0190

1 Labo District Hospital, Labo

(054) 585-2551

Camarines Sur Bicol Medical Center, Camarines Sur

1 (054) 811-7800 local 322

I riga City Health Office, lriga City

Naga City Hospi ta l, Naga City

(054) 472-0464

Ragay District Hospita l

0921-5344176/0928-5077307

Libmanan District Hospital

Nabua RHU

Catanduanes Eastern Bico l Medical center, yirac

0928-2890534

M asbate

I Pandan District Hospita l. Pandan

0920-7436595

Viga District Hospita l

1 0918-6946138

i : Cataingan District Hospital, Cata ingan

0928-6051086/ 0920-4224799

Masbate Provincial Hospital, Masbate City

(056) 333-2244

Tlcao District Hospital, San Jacinto

0918-4934071

Claveria District Hospital

0920-8094220

Estela Zenit, M D

!Berlyn Villanueva, MD

Ramon Echano, MD

09193237255

09175584996

09065709543

jJose Vernon Banal, MD 09065709543

Maria LitamJvtl) 09189057064

Jose Gimenez, MD 0997202622

(054) 299-2465

Lunining Luciano, MD 472-0559

Milfred Bayot, M D 09285077307

(054) 511-8760

Teodora Pornillos, MD 09204590016

I

Monista Lacorte, MD

Rafae l M ariano, MD 09207436595

Nerissa Guerrero, MD 09156284185

Jovan Lim, M D 09204224799

Cynthia Llacer, MD 09184525603

Jesus Camposano 09285208751

Glenn Andueza, MD 09204670321

l)

I I I

I

Sorsogon

REGION VI

(WESTERN VISAYAS)

Aklan

Antique

Dr. Fernando Duran Memorial Hospital, I

Sorsogon City

(056) 211-3809

l rosin District Hospital, I rosin

0919-8797037

Donsol District Hospital, Donsol

0915-8492714/ 0920-1544880

Gubat District Hospital

(056) 311-1100

Sorsogon City Health Office, Sorsogon City

Vicente Peralta Mem Hasp

34 ABTCs

Rafael S. Tumbokon Mem' l Hospi tal, Ka libo, Aklan

268-5626

Arige l Sa lazar M em' l Hospital, San Jose, Antique

540-8880

Ma rlen Gapayao, MD

Ludovic Tan, MD

Joseph Chavez,MD

Franco Lagatuz, MD

Ruel Rebustillo, MD

Charlie Bandola, MD

Capiz Roxas Memorial Provincial Hospital, Arnalda Blvd. Roxas City

0918-3248004/0928-7037542

Roxas City Health Office, Bangbang St., Roxas City

62 1-0578

Iloilo Iloilo City Health Office

337-5284

Passi City Health Office

311-5046

Passi District Hospital, Passi City

311-5453

Western Visayas M edical Center, Mandurriao, Iloi lo City

32 1-2841 local 190

I loilo Provincial Hospital, Pototan

529-7498

Rep. Pedro Trona M emorial District Hospital, Guimbal

315-5172/ 512-0234

09175874592

09175874592

09201544880

09275149299

0918-6985412/ 0917-

8680633

09206096708

10

l

·'

Ramon Tablana Mem'l District Hospital, Cabatuan

522-8211

Federico Ramon Ti rador Sr, Mem' l Hospital, Janiuay

317-1319

Sara District Hospital, Sara

392-0144

Dr. Ricardo Y. Ladrido Memorial District Hospital, Lambunao

349-1578

Barotac Viejo District Hospital, Barotac Viejo

362-0300

Balasan District Hospital, Balasan

397-0169

Negros Occidental Bacolod City Health Office

434-4098

Bago City Health Office

461-0118

Cadiz City Health Office

0919-5741226

Escalante City Health Office

0920-8811150

Himamaylan City Health office

388-3504

Kabankalan City Health Office

471-3069

La Carlota City Health Office

460-2683

Sagay City Health Office

0919-3454537

Silay City Hea lth Office

495-5018

San Carlos City Health Office

0916-3124291

Tallsay City Health Office

0919-4416675

II

I • I

Guimaras

REGION VII

(CENTRAL VISAYAS)

Cebu

Negros Oriental

Sipalay City Health Office

0909-6521275

Victorias City Health Office

399-3437

Dr. Jose Locsin Mem. Prov. Hosp., Silay City

Escalante District Hospita l

454-8015

Kabankalan District Hospi tal

471-2357

Don Salvador Benidecto Mem'l Hospital, La Carlota City

460-3360

Guimaras Provincial Hospital, Jordan, Guimaras

581-3331

27 ABTCs and 3 ABCs

Provincial Health Office, Cebu Provincia l Capitol, Cebu

City

Cebu City Health Department, Cebu City

Danao District Hospital, Danao City

Minglanilla District Hospital, Minglanilla, Cebu

Lapu- Lapu City Health Office, Lapu-lapu City

Mandaue City Health Office, Mandaue City

Tuburan Rura l Health Unit, Tuburan, Cebu

Medellin Rura l Health Unit, Madellln, Cebu

Maiabuyoc District Hospita l, Malabuyoc, Cebu

Argao District Hospital Hospita l, Argao, Cebu

Bari li District Hospita l, Barili, Cebu

Toledo City Health Office, Toledo City

Bantayan District Hospital,. Bantayan, Cebu

Oslob District Hospital, Oslob, Cebu

Ricardo Maningo District Hosp' l, Camotes, Cebu

Negros Oriental Provincia l Hospital, Dumaguete City

Contact Number

032-253-9773

032- 232-6969

032-200-4482

032-490-2937

032-340-5339

032-346-0110

032-463-9007

032-436-2019

032-516-1495

032-367-7500

032-470-9026

032-322-5239

032-352-5231

032-4819985

035-225-9291

12

I .,

Dumaguete CHO, Dumaguete, City

Slato n District Hospital, Slaton, Negros Oriental

Bendoy District Hospital, Bendoy, Negros Oriental

La Libertad RHU, La Libertad, Negros Oriental

Bayawan District Hospital, Bayawan, Negros Oriental

Bais District Hospital, Bais City Negros Oriental

Siquijor Siquijor Provincial Health Office, Siquijor

Bohol

REGION VIII

(EASTERN VISA VAS)

Garcia Memorial Provincial Hospital, Talibon, Bohol

Celestino Gallares Memorial Hospital, Tagbilaran City

Emilio del Valle Memorial Hopspital, Ubay, Bohol

Private (Family Vaccine)

I 16ABTCs

• Teodoro B Galagar District Hospital,

Jagna, Bohol

• Cong. Natalia P. Castillo Sr. Memorial

Hospital, Loon, Sohal

• Carmen Memoria l hospital, Carmen,

Bohol

Tacloban City Eastern Visayas Regional Memorial Center

Tacloban City Hospital

Leyte Leyte Provincial Hospital, Pa lo, Leyte

Ormoc City Health Office

Western Leyte Provincial Hospital

Southern Leyte Salvacion M Ynlgues Memorial Hospital, Maasln

Anahawan District Hospital

Biliran Biliran Provincial Hospital, Nava l

035-225-2535

035-427-0307

035-405-3034

035-409-4020

035-531-0485

035-407-8317 I 402-3194

'035-344-2014

038-515-5081

038-411-4 868/4 869

038-518-0379/0324

,038-525-9510

038-505-9426/9170

038-2382-405

(053) 523-2809

(053) 323-3151

(053) 323-3057

255-2225/4062

381-2368/2396

500-9179

13

I • I

Samar Samar Provincial Hospital, Catbalogan, Samar

Ca lbayog City Health Office, Calbayog City

Eastern Samar Eastern Samar Provincial Hospital, Boronga n

' Oras District Hospital I

· Fel ipe Abrigo Memorial Hospital 1.__ ·-· --- -- . .

I Albino Duran Memorial Hospital

, Can-Avid District Hospita l, Can-avid

Northern Samar i Nort hern Samar Provincial Hospital, Cat arman

356-1423

209-2617/ 2790

560-9555

500-9032/9308

i REGION IX

(WESTERN

MINDANAO)

17 ABTCs Contact Person I Contact Number

I

I __ _j

Zamboanga City Zamboanga City Health Office, Petit

Barracks

Zamboanga City Medical Center, Dr.

Evangelista St., Sta. Catalina

Labuan Public Hospital, Brgy. Labuan

Zamboanga del Norte Dipolog City Hea lt h Office, Brgy.

Estaka, Dipolog City

Zamboanga del Norte (ZDN) Medical

Center, Brgy. Sicayab, Dipolog City

Dr. Jose Riza l Memoria l Hospital,

Brgy. Lawaan, Dapitan City

Sindangan District Hospita l,

Slndangan

Liloy Integrated Hospital, Liloy

Zamboanga del Sur Pagadian City Health Office

Aurora General Hospital

Margosatubig Regiona l Hospital,

Margosatubig

Zamboanga del Sur Medical Center,

Pagadian City

I I

--- ___ ., ______ _L

'o62) 991-5421

I - ·- ----!(o62l 990-4769/ 991-0573 I

1(062) 926-0259

I (065) 212-3400

:(065) 212-5080/212-5081/ fax

1212-3625

(065) 213-6421

,(062) 211-5634

I

14

I

·'

Zamboanga Sibugay Zamboanga Sibugay Provincia l

Hospital, Brgy. Sanito, lpil

Olutanga Municipal Hospital, Brgy.

Bater ia, Olutanga

Alicia Dist rict Hospital, Alicia

lsabela City Basilan General Hospita l, lsabela

City, Basilan

REGION X

(NORTHERN

MINDANAO)

lsabela City Health Office, I sa be la

City, Basilan

: 20ABTCs

Bukidnon Bukidnon Provincial Hospitai -Maramag

Bukidno n Provincial Hospitai -Malaybalay

Manalo Fortich RHU

Malaybalay City Health Office

Cagayan de Oro City Health Office

Va lencia City Health Office, Valencia, Bukidnon

Misamis Oriental Misamis Oriental Provincial Health Office

Clajavita ILHZ, Misamis Oriental

Galileo ILHZ , Misamis Oriental

Manluna ILHZ

Gingoog City Health Office

Misamis Occidental Misamis Occidental Provincial Hospital, Oroquieta City

Ozamiz City Health Office, Ozamiz Ctiy

Oroquieta City Health Office (additional)

camiguin Camiguin Provincia l Hospital

Lanao del Norte Lanao del Norte Provincial Hospital, Baroy

lligan City Health Office, lligan City

Kolambugan District Hospital, Lanao del Norte

Kapatagan District Hospital, Lanao del Norte

Cagayan de Oro City Cagayan de Oro City Health Office

-· I (062) 333-2323

15

I • I

REGION XI

(DAVAO)

Northern Mindanao Medical Center

19 ABTCs and 4 ABCs

Davao City City Health Office

Paquibate District Hospita l

Davao Medical Center

Davao del Norte Oavao Regional Hospital, Tagum City

Kapa long District Hospita l, Kapalong

Sa mal District Hospita, Samal City

Carmen District Hospital, Carmen

Panabe City Health Office

Compostela Valley M ontevista District Hospital, Montevista

Pantukan District Hospital, Pantukan

Maragusan Municipa l Hospital, Maragusan

Laac Community Hospital, Laac Compostela Valley

Davao del Sur Davao del Sur Provincia l Hospital, Dlgos City

Mal ita District Hospital, M alita

Matanao Medicare Commu nity Hospital, Matanao

Davao Oriental Davao Oriental Provincial Hospital, M ati City

REGION XI

(DAVAO)

Lupon District Hospital, Lupon

Manay Community Hospital, Manay

Cateel District Hospital, Cateel

Satellite ABCs:

Laak Community Hospital

Maragusan Community Hospita l

Panabo City Health

Bunawan District Office

19 ABTCs and 4 ABCs

Davao City 1 City ~ealth Office

16

I ..

Paquibate District Hospital

Davao Medical Center I

Davao del Norte Davao Regional Hospital, Tagum City

, Kapalong District Hospital, Kapa long I

I Samal District Hospita, Samal City

J Carmen District Hospital, Carmen

' Panabe City Health Office

Compostela Valley Montevista District Hospital, Montevista

I j Pantukan District Hospital, Pantukan

Maragusan Municipal Hospita l, Maragusan

1 Laac Community Hospital, Laac Compostela Valley I

Davao del Sur ! Davao del Sur Provincial Hospital, Digos City

Malita District Hospital, Malita

Matanao Medicare Community Hospital, Matanao

i Davao Oriental Davao Oriental Provincial Hospital, Mati City

REGION XII

(SOCCKSARGEN)

Lupon District Hospital, Lupon

[ Manay Community Hospital, Manay

I Cateel District Hospital, Cateel

Sate llite ABCs:

Laak Community Hospital

Maragusan Community Hospital

Panabo City Health

Bunawan District Office

Ill ABTCs

I ~ Cotabato Regional Medical Center, Cotabato City (064) 421-2192

Cotabato Provintial Hospital, Amas, Cotabato

South Cotabato Provincial Hospital, Koronadal

City

' Kidapawan City Health Office

0928-5078007

(083) 552-3141

(064) 288-1377

17

I • I

CAR

l Dr. Amado P. Diaz Provincial Hospital Midsayap, 0908-4676455

Cotabato

, General Santos City Hospital

Lebak Medicare Community Hospital, Lebak,

Sultan Kudarat

0919-2533901

0910-3996771

Polomoloc Rural Health Unit, Polomoloc, South {083) 225-2035

Cotabato

Tacurong City Hea lth Unit, Tacurong City

Sultan Kudarat Provincial Hospital, lsulan, Sultan

I Kudarat

Sarangani Provincial Health Office, Alabel,

Sa ranganl

8ABTCs

{083) 508-2285

Benguet Benguet Provincia l Health Office, Benguet General Hospital Compound, La Trinidad, Benguet

Apayao Apayao Provincial Hospital, Kabugao, Apayao

Sta. M arcela RHU, Santa Marcela, Apayao

A bra Abra Provincial Hospital, Bangued, Abra

lfugao lfugao Provincial Health Office Lagawe, lfugao

M ountain Province Mountain Province Provincial Health Office, Bontoc

Kalinga Ka linga Provincial Hospital, Bulanao, Tabuk City

Baguio Baguio City Health Service Office, T. Alonzo St., Baguio City

CARAGA 21 ABTCs

Agusan Del Norte Provincial11ospital Agusan del Norte, Llbertad, Butuan City

Cabadbara n District Hospital

Nasipit District Hospital

Agusan Del Sur D. 0 Plaza Memorial Hospital

Bunawan District Hospital

Surigao Del Norte Caraga Regiona l Hospital

Del Carmen Distric Hospital

I ll

I,

'

Malimono District Hospital

Pillar District Hospital

Socorro District Hospital

Siargao District Hospital

Surigao Del Sur Adela Sierra Ty Medical Center, Tandag

Bislig District Hospital, Managoy, Bislig

Hinatuan District Hospital

Lianga District Hospital

Madrid District Hospita l

Dinagat Islands Dinagat District Hospital

Alber District Hospital

Lo reto District Hospita l

Butuan City Butuan City Medical Center, Langlhan, Butuan City

Surigao City City Health Office, Surigao City

NATIONAL CAPITAL

REGION

· 21ABTCs

Referral Hospitals Research Institute for Tropical Medicine (RITM), Ala bang, Muntinlupa City

District I

District II

San Lazaro Hospital, Sta Cruz, Manila

Philippine General Hospita l, Tah Avenue, Manila

Pagamutang Bayan ng Malabon, Maya-Maya St. cor .

Dagat-Dagatan Avenue, Malabon City

Navotas Emergency & Lying-in Clin ic, M. Naval St., San

Jose, Navotas

Malinta Health Center, Brgy. Hal l, Malinta, Va lenzuela

City

Bagong Silang Health Center, Phase I, Brgy. Bagong

Si lang, Caloocan City

Marikina Health Office, Prissa Bldg., Shoe Avenue, Sto.

Nino, Marikina City

Pasig Health Office, Market Avenue., Pasig City

(02) 285-2898/ 285-2804

(02) 281-8728

(02) 445-1406

(02) 962-8206

(02) 998-5045

(02) 642-7754/ 640-2058

19

~ ,,

i ARMM

. Delfin Sa longa Health Center, Emerald Court Subd ., Sto. (02) 641-3246

Rosario, Pateros

lbayo Health Center, Natividad St., Bry. lbayo, Tipas,

Taguig City

Quezon City Employees Clinic, Quezon City Health

Department, Kalayaan Avenue, Quezon City

District Ill Makati Health Departme nt, Makati City Hall, J.P. Rizal

Avenue, Makati City

Mandaluyong Health Office, Bani Ave., Maysilo St.,

Mandaluyong City

San Juan Health Office Unit I, Municipal High School,

Narciso St., San Juan City

Main Health Office, San Juan Unit II, P. Narciso St.,

Pinaglabanan, San Juan City

. Manila Health Department, Division of Preventable

Diseases, Manila City Hall

District IV Las Pinas Health Center, Pam plana Ill , Las Pinas City

Silverio Healt h Center, Paraiiaque City

Alabang Health Center, National Road, Putatan,

Muntinlupa City

San Isidro Health Center, Domingo St., Pasay City

. \ : ; ' i• •..rt•_,....,_.;. ·;~.!~ .. ~

Maguindanao M aguindanao Provincial Hospita l

Datu Blah District Hospital

Lanao del Sur Wao District Hospital

Sulu Sulu, Provincial Health Office

Sulu Sanitarium. Jolo Sulu

Dr. Majid - 09277704 77 1

(02) 642-2462

(02) 926-4237 I 926-4201

(02)895-4001 1oca l 604/606/607

(02) 534-0163

(02) 744-0736

{02) 724-027 1

(02) 527-4941

(02) 871-3909/ 873-9145/ 872-3169

(02) 826-9712

(02) 842-2560

(02) 831-5275

20

SUMMARY

17

II 16

Ill 28

IV-A 48

I V-B 34

v 24

NCR

i 21

. =·r . ~ · .:

'1: ': . ::\ ... ·-·--·

ABC

.:.. . .'.:.:·· : ......

... : I ": ,,· .·:!

•. ""·1

CAR I 8 I .

.. ·-~.~~ :~ _ t~=c;-;!~~Ii~t";:.·~ .:~: :~~c-:·.1 VI I

I 34

VII . -·· -r----------· ; -7

i

--~-- -~~~~~;~--r:· _ ... ·:·.··-···-·: -···· 16

i J 1 I

I 3 ! ····-··-···-·--·-·-····--····-·-·-·-····1

I

I

', 1

2 1

•'

Annex C

Proper filling up Animal Bite Package Forms for Reimbursement

A. Claims Summary Report (CSR)*

1. Indicate Provider Code or Accreditation number in the space provided 2. Columns:

a. Patient's name b. Encircle the letter M if patient is member or Dis dependent c. PIN (PhiiHealth Identification Number) d. lCD code of the diagnosis e. Date of administration of the 1st dose of anti rabies vaccine (ARV) f. Date of administration of Day 3 ARV g. Date of administration of Day 7 ARV h. Date Rabies Immunoglobulin was administered i. Signature of member to confirm services were rendered

3. Authorized signatory at t he lower left portion of the form is the personnel in charge of fi lling up of PhiiHealth claims

4. Head of facil ity - MHO, CHO or Chief of Clinic Note: • Each patient or member's claim listed should have Claim Form (CF)1 att ached. If there are 7 patients listed,

there should be 7 claim form 1 attached to the CSR. • Incomplete data in CSR may resu lt in withholding of reimbursement subject to submission of Animal Bite

Treatment Record. *The CSR is a list of patients who are recipient of ABP and whose reimbursement shall be paid to the facility

B. Claim Form 2 for directly Filed Claims

All items must be properly fi lled-up · Part 1

• Item #10. Confinement period a. Date admitted - Day 0 o f treatment b. Date discharged - Day 7 of treatment e. No. of days cla imed - 1

• Item #11 e. 11. Health Care Provider Services Actual Charges PhiiHealth Benefit

e. Benefit packages - ABP P3,000 P3,000

• Item #16. Leave this blank is patient is private

Part II

For PhiiHealth use on I

• Under the Generic/ Brand name, write the immunizations and date administered. To illust rate:

PART II DRUGS AND MEDICINES Generic/ Brand Name Preparation Quantity Unit Price RIG May 3, 2012 DayO May 3, 2012 Day 3 May 6, 2012 Day 7 May 10, 2012

• In case of incomplete vaccination due to hospital admission or death of patient, write the word admitted and the name of the hospital and date of admission (in case of admission) or date of death (as the case maybe). To illustrate: a) Hospital admission of patient

PART II DRUGS AND MEDICINES

Generic/ Brand Name Preparation Quantity Unit Price RIG - May 10, 2012 Day 0 - May 10, 2012 Day 3 - Admitted; Phil. Gen. Hospital; May 11,2012

b) Repeat exposure

PART II DRUGS AND MEDICINES Generic/ Brand Name Preparation Quantity Unit Price RIG -Day 0 -

Day 3 -Day 7 -

Day 28 -Booster 1 - May 12, 2012