GSIS Hospitalization Support Program (GHSP)

All admitted or out-patient GSIS active members or pensioners can now enjoy
10 - 50% discount after Philhealth deductions. All they need to do is present their
E-card to our clerk at our Admissiions Office (in case of admission) or to our
Business Office staff (for out-patients) upon payment.

The following are the discounts they can enjoy:

50% off on MRI and CT-Scan
40% off on Common Procedures like:
Electrocardiography, X-ray, Ultrasound, and all Laboratory exams
35% off on Special Procedures like:
2D-Echocardiography, Treadmill/Stress Test, Coronary Angiography,
Arterial Doppler, Mammogram, Nuclear Medicine procedures,
3D Conformal, Chemotherapy, Radiotherapy, Holter Monitoring,
Endoscopy

30% off on Room and Board Rates (ICU Complex, ER, OR, RR and DR)
30% off from marked-up price
Medicines and supplies used in line with the hospitalization, out-patient
consultation/procedure or emergency care

10% off based on agreed HMO rates

Professional fees for services rendered at the hospital

Dependents of active members are also entitled to a 10% discount on all medical
services, supplies and professional fees. They just need to be accompanied by the
GSIS member or pensioner with their E-card.
Members/pensioners must present an E-card or UMID card to be able to avail of
the above discount. In the absence of an E-card or UMID card please secure a
Certificate of Eligibility (COE) from the GSIS office nearest to them.
Admission and Discharge

GENERAL INFORMATION
- The hospitals policies and procedures will be explained to you briefly by our
--information assistant to make your stay with us as convenient as possible.

- Philhealth forms 1, 2 and 3 will be given to you to accomplish during your stay in
the hospital.

- Please accomplish your Philhealth benefit requirements while still in the hospital
not when you are going home already to avoid inconvenience.

- During your stay with us you will be given a regular update of your hospital bill
for your perusal.

GUIDELINES FOR EMERGENCY CASES

If a call for reservation is made, room reservation will be kept for two to three
hours only.

While the patient is in the emergency room, the companion is requested to go to

the Admitting section for the following:

a. Make a choice of Room Accommodation (depending on availability).

b. Provide the admitting assistant the patients pertinent information for
proper documentation and recording

_(1) CORPORATE or HMO

- Company/HMO/SSS/GSIS/OWWA Member/Dependent/Pensioner, etc.
- Please present a Letter of Authority from the Company/HMO or a
membership/company identification card for emergency admission

_(2) PERSONAL
- Cash or Credit Card
- An initial payment is required which is relative to room of choice as well
as the case of admission.

GUIDELINES FOR NON-EMERGENCY CASES

I. PRE-ADMISSION
a. Room Reservation
- You may call the hospital information assistant for your room reservation before
coming for admission. Reservations can only be kept overnight prior to admission.
Please advise the exact date of your arrival at the hospital.
- Inquiries regarding room rates and amenities will be gladly entertained.

b. You may call our Hospital Information Assistant at (6332) 232-2437 or

233-8620 locals 100, 107 or 150.
__(1) CORPORATE or HMO

- Availment of Health Insurance Benefits

Our Hospital Information Assistant can give you information on what
documents to prepare if your hospital expenses are taken cared of by your Health
Insurance, by a Company, by Philhealth (Medicare).

The hospital will bill your insurance company directly. We will bill you for any
hospital fees not covered by your insurance or by your company or by Philhealth.

__(2) PERSONAL Cash or Credit Card

- We will be asking for an initial payment which is relative to the case and
room availed of.
TIPS FOR A HASSLE-FREE DISCHARGE
_1. The doctor gives you the order to go home. Before going down to the Billing
Section, please verify first from the Nurses Station if the following have been
submitted to the Billing Section:
- Notice of Discharge
- Professional Fee/s of your Doctor/s
- Philhealth Forms 2 and 3 (if patient has Medicare) duly signed by
--the Attending Physician or Resident
- Photocopy of Surgical techniques or Operating Room Records
(if applicable)
- Labor Record and OB History (if applicable)
- If unused medicines and supplies have been returned so that they will be not be
included in the computation of the final hospital bill

_2. If the above documents have been submitted to the Billing Section you may
go down to the Philhealth Assistance Counter found inside the hospital
Business Office and submit your Philhealth Form 1 (if not yet submitted) for

evaluation and computation of the amount of benefit you can avail of.
_3. Go to the Billing Counter for your final Hospital Billing Statement.
_4. Proceed to Cashier for payment. Always ask for an Official Receipt and
count your change before leaving the counter.
_5. You will be given 2 copies of Discharge Slip. Please give one (1) copy to the
Nurses Station and the other (1) copy to the security guard.
WHAT ARE YOUR POSSIBLE BENEFITS?
_1. For Currently Employed Member:
The original and properly accomplished Form 1 is sufficient. If in case the
Certification of Employer is not properly accomplished due to separation
from employment, but contribution is still qualified for the confinement
period, submit RF-1 and ME-5 and/or applicable receipts of at least six (6)
months prior to admission. See below for the additional requirements.

_2. Beneficiary/Hospital representative to attach the following supporting

document/s for:
a.) Individually paying (voluntary, self-employed or OFW members), any of the
______following:
- Official Receipts of Philhealth accredited collecting banks or
- Philhealth Bank Receipts (PBR)
- Duly Validated MI 5 (Contributions Payment Return Form) for
- individually paying members starting January 2000
- Official Receipts issued by Philhealth (for over the counter payments)
b.) SSS/GSIS Retirees, any of the following:
- SSS PRINT OUT DDR
- Retirement Certificate issued by GSIS

- Insert GSIS process

c.) AFP/PNP Retirees, any of the following:
- General or Special Orders
- Certification of 120 monthly Medicare/NHIP contributions from
GSIS or from previous employer
- Service Record
d.) Retired Judges, any of the following:
- Certificate of Retirement from the Office of the Court Administration
(OCA)
- Certification of 120 monthly Medicare/NHIP contributions from the
GSIS or from the employer
- Service Record
e.) SSS Partial Disability Pensioner certificate from SSS indicating coverage/
period of pension
Note: For disability and survivorship pensioner after March 4, 1995 is no
longer compensable.
f.) Dependents of a, b, c, and e approved M1b or E1/E4 for SS members or
NEWBORN - Medical Certificate
SPOUSE copy of marriage contract
CHILD copy of birth or baptismal certificate
- Illegitimate/Legitimate child birth certificate acknowledged
by the father/mother or notarized affidavit of support
- Legally adopted child legal adoption paper or notarized
affidavit that child is legally adopted
- Step-child
*birth or baptismal certificate with copy of marriage contract or

*affidavit by the step-mother or step-father

PARENT affidavit of support (original or Certified true copy)
g.) OWWA member/dependent Certified True Copy of Medicare Eligibility
Certificate (MEC) for undeclared dependents
SPOUSE authenticated photocopy of Marriage Contract and Birth
Certificate
CHILD authenticated photocopy of Birth Certificate
PARENT affidavit of dependency/support and authenticated
photocopy of Birth Certificate
*For patients with operation/procedure performed: attached photocopy of:
a. Operating Room Record
b. Surgical Technique
*Endoscopy - for procedures done at bedside
*Colonoscopy - photocop of nurses notes or Physicians order
*For OB patients - OB History, labor Record, POGS
If: CS, additional requirements:
a. Surgical technique
b. Anesthesia record
c. Operation record
Note:
1.) Admission starting May 1, 2003 , second normal delivery is compensable.
2.) Admission less than 24 hours without procedure is not compensable.
3.) Dependent parents should be at least 60 years old.
4.) Dependent children should be below 21 years old.
LEGEND: RF 1 - Quarterly Remittance form
ME 5 - Contributions Payment Return form for employed sector

MI 5 - Contributions Payment Return form for individually

Paying members
M1b - Membership Data Record form for individually paying
E1 - SSS Membership form for new member
E4 - SSS Members Data Amendment form
HOW TO TAKE CARE OF YOUR BILLS THE FAST AND EASY WAY?
Requirements for Patients to charge hospital bills to Health Maintenance
Orgranizations (HMO):
1. Letter of Authorization two (2) copies
a. 1 original copy
b. 1 duplicate/photocopy
2. Insurance Claim Forms (if required by Insurance Company)
3. Philhealth Forms 1, 2 and 3 (if required by the Insurance Company)
Philhealth Form 1 should be duly signed by the member and employer
(if employed).
Philhealth Form 2 should be duly signed by the Attending Physician only
Philhealth Form 3 should be duly signed either by the Attending Physician,
Resident Doctor. (*These Forms will be given to you in the Admitting
Section upon admission.)
4. Doctors APR -Attending Physicians Report (Optional)
5. Clinical Abstract/Discharge Summary (Optional)
6. Other documents required by the HMO/Insurance as stated in the Letter of
Authority
Requirements if Patient bills is charged to a private company:
1. Letter of Authorization two (2) copies
a. 1 original copy

b. 1 duplicate/photocopy
2. Philhealth Forms 1, 2 and 3 (if required by the Company)
Philhealth Form 1 should be duly signed by the member and employer
Philhealth Form 2 should be duly signed by the Attending Physician only
Philhealth Form 3 should be duly signed either by the Attending Physician,
Resident Doctor or PGI.
(*These Forms will be given to you in the Admitting Section upon admission.)
PERPETUAL SUCCOUR HOSPITAL SCHEDULE OF SERVICES:
1. BUSINESS OFFICE DEPARTMENT located at the ground floor of the Main
Building adjacent to the Admissions Office
a. Billing Section
7:00 AM to 7:00 PM (Monday to Saturday)
8:00 AM to 7:00 PM (Sundays and Holidays)
b. Medicare Section
8:00 AM to 5:00 PM (Monday to Saturday)
8:00 AM to 12:00 NN (Sundays and Holidays)
1:00 PM to 5:00 PM (Sundays and Holidays)
c. Cashiers Section
(Main Building)
6:00 AM to 7:00 PM (Monday to Saturday)
8:00 AM to 12:00 NN (Sundays and Holidays)
1:00 PM to 5:00 PM (Sundays and Holidays)
(SPC Medical Specialty Building)
8:00 AM to 12:00 NN (Monday to Friday)
1:00 PM to 5:00 PM (Monday to Friday)
*Payments are accepted at the Information Counter:

7:00 PM to 6:30 AM Monday to Sunday

d. Admitting/Infomation/Operator Assistance is open 24 hours daily.
2. FOOD CENTERS
a. Canteen located at the back of the Main Building
6:30 AM to 7:00 PM (Daily)
b. Sisters Best 1 - situated at the Main Building across the Admistrators
Office
- Open from 7:00 AM to 11:00 PM
- (Except on Sundays. It closes at 3:00 PM and opens the following
day at 7:00 AM)
c. Sisters Best 2 to be found at the 2nd floor, SPC Medical Specialty Center
____________7:00 AM to 7:00 PM Monday to Saturday
3. MEDICAL IMAGING CENTER situated at the ground floor of the Main Building
near the elevator.
a. X-ray
- Service Hours: Opens 24 hours daily
- Procedures:
A written request from your attending physician will be asked from you. You have
the option to pay in cash or charge (company or HMO).
(1) If payment is in cash:
Pertinent information of the patient must be given.
A charge ticket will be given to you by the receptionist for you to present
to the Cashier at the Business Office for payment.
Present the Official Receipt to the Receptionist for her to give you your
schedule for X-ray.
(2) If payment is charge to a company or an HMO

 You will be asked to proceed to the Out-Patient Department for registration.

Should you have registered already, the Receptionist will give you an X-ray
Request Form for you to completely fill up.
You will then be given your schedule for X-ray.
All films are kept on file in the MIC, should you want to get the X-ray film, you
need to present an authorization letter from your attending physician.
In preparation, you need to remove all metallic and opaque objects from the part
of the body to be X-rayed (pins, hairpins, earrings, etc.).
b. Ultrasonography Section
- Service Hours: Mondays to Fridays - 7:00 am - 12nn and
2:00 pm - 4:00 pm
Saturdays - 7:00 am - 12:00 nn
For Emergency cases at any day or time
- Procedures :
Request forms are sent immediately to the MIC department completely filled out
with the pertinent information on the patient.
You will be accompanied to the Ultrasonography Unit by a Nursing Service
personnel together with your chart.
One copy of the official results is attached to the chart, while the other copy is
retained in the MIC file.
All procedures are paid in cash except for those who are subsidized by their
respective companies. Please note that all procedures can only be performed when
the Official Receipt is presented.
4. PULMONARY LABORATORY can be found at the ground floor of the main
building at the corner going to the Kidney Service
- Open 24 hours a day

- Services are available for both in-patients and out-patients

5. CLINICAL LABORATORY is located at the ground floor of the Cebu Heart
Institute
- Requests are logged in the computer or in the receptions logbook
(for prescribed patients)
- Extraction of sample then takes place per clinicians order
- Medical Technologist goes back to the laboratory with the specimen
obtained from the patient
- Specimen is delivered to the corresponding section where the
requests belong
- Ordered laboratory examinations are performed properly and
correspondingly
- Results are released from the section and are then forwarded to the
respective nurses station
6. MEDICAL RECORDS - is situated at the back of the main building and is open
from Mondays thru Saturdays from 8:00 a.m. to 5:00 p.m.
A. Release of Medical Records to Authorized Persons
- Release of medical data/information is done by the Medical Records
Clerk under the supervision/approval of the Administrator. Other
personnel in the hospital are not authorized to release data from the
patients chart.
- Patient waives claim to privacy when authorization is received, signed
and witnessed.
- Authorization for minor or legally incompetent persons may be signed
by patients, guardian or legal representative.
- An authorization for release of information especially confidential in

nature should be signed by the patient or whoever is the responsible

party when such information is to be released in the absence of any
specific law to the contrary.
B. Policies for Release of Information
- All requests should be written and not verbally made.
- Patients who seek information on their own cases should be referred
to the attending physician.
- Should a patient request for copies of laboratory, X-ray results, etc.,
a written order from the attending physician must be submitted.
- No Medical staff, Residents, PGIs are to release medical data in
verbal or written form, except when discussing the progress to the
patient with the relatives or interested party.
- Visiting Physicians not affiliated with the hospital should present
authorization papers signed by the patient to secure any medical
record from the Medical Records Section.
- No information (e.g. lab results, etc.) shall be relayed by the staff
over the phone per the doctors secretarys request.
- Employers paying for their employees confined in the hospital should
have written authorization from the patient before medical data is
released.
- Members of the Medical Staff may not give authorization to Insurance
companies or Lawyers to secure a patients record.
- Insurance companies must secure a written request from the
attending physician and authorization from the patient and company
representing them to secure the medical records of the patient.
- The hospital will not use the medical record to jeopardize the interest

of the patient except to defend itself in a court of law.

- Medical Records shall not be taken outside the hospital except for
Subpoena Duces Tecum or specified written authorization of the
Administrator. Consequently, all records should be kept safe in the
Medical Records Section except when needed in the clinical areas
- In Subpoena Duces Tecum try to have the court accept photocopy.
If not, have the court issue a receipt for original copies.
- The hospitals legal representative has access to the patients medical
record without authorization from the patient if the patient has
brought a lawsuit against the hospital.
Contents of Medical Records to be released:
Patients history
Discharge summary
Laboratory results
Operative/delivery record
Except for subpoenaed charts
Certificates Released by the Medical Records:
- Medical Certificate
- must have a written order by the attending physician;
- only specified requests e.g. Medical Certificate, Laboratory results,
etc. will be given out.
- Death Certificate the relatives or the funeral parlor will be
responsible for the registration
- Fetal Death Certificate
- Babies whose birth weight is 500gms and above will be given the
certificate

- The relatives or the funeral parlor will be responsible for the

registration
- Live Birth Certificate
- For package deal patients or those whose doctors are holding clinics
at Perpetual Succour Hospital, the certificate will be released two
weeks after discharge
- For those whose doctors are not holding clinics at Perpetual Succour
Hospital, the certificate will be released two weeks to a month after
discharge
7. RELIGIOUS SERVICES
A. Daily Mass Schedule
- Weekdays 6:30 am
- Wednesdays and Fridays - 12:15 pm
- Wednesdays 6:00 am
- 1st, 4th, and 5th Sundays 7:00 am
- 2nd, and 3rd Sundays 6:00 am
B. Holy Communion
- Administered right after the morning masses
- Communicants are endorsed by the nurses
C. Daily Prayers
- Angelus 6:00 am, 12:00 nn, and 6:00 pm
- 3 o clock prayer
D. Other Services
- An in-house Chaplain is available to perform the Sacrament of
Reconciliation, celebrate the Holy Eucharist, and administer the
Anointing of the Sick to patients upon arrangement with the staff on

duty or the Supervisor.

- Daily visitation is being done by the Chaplain, Sisters and other
Lay Volunteers.
- The Chapel is only opened to celebrate the Holy Eucharist. However,
we have a Prayer Room that is open 24 hours a day. This is located
at the 2nd Floor of the main building adjacent to the ICU.
8. CARDIOVASCULAR LABORATORY
A. Scheduling
I. In-patients
The nurse on duty at the station will be the one to schedule the
procedure by calling and sending a request to C.V. Lab.
II. Out-patients
The attending physician's secretary or the patient himself will
call C.V. Lab for scheduling preferably at least a day before the
desired schedule.
Note: Patients are exhorted to come to C.V. Lab at least 15 mins.
before his/her schedule.
B. Payment
I. In-patients
The floor nurse should refer to the business office for clearance
of the patients with C.V. Lab procedures. If patient is cleared,
C.V. Lab should be informed so as to finalize the schedule. If
patient is not cleared, they should be advised to prepare the
amount needed for the procedure then get the charge ticket
from the C.V. Lab and pay it at the cashier.
Note: Final schedule will only be given once patient is financially

cleared.
II. Out-patients
- Payment is either made in cash, credit card or c/o company/
insurance.
- Those who will pay in cash or credit card should get a charge
ticket from C.V. Lab then make the payment at the cashier.
- Those who will be charged c/o insurance/company should bring
a letter of authorization and submit it at the out-patient
department then bring the approved request from OPD to
C.V. Lab.
C. Preparation
I. 2D-Echo Doppler - no special preparation
II. Stress Test
- Wear rubber shoes or any comfortable walking shoes
- Wear jogging pants/walking shorts or any comfortable clothing
- Avoid eating a heavy meal before the procedure (within an
hour)
III. Vascular Studies - no special preparation except for Renal and
Abdominal Aorta Duplex Scan
Note: Instruction will be given upon scheduling of procedures
IV. Invasive Procedures - preparation instruction will be given by the
attending physician or cardio-fellow.
9. Kidney Service
A. In-patients
- Alert the Renal Unit for impending hemodialyis. Secure doctor's order.
- If with no vascular access, secure consent for operation and clearance from

the Business Office before operation.

- Secure patient's consent for hemodialysis.
- Refer patient's family and/or significant other/s to the Renal Unit for the
run-down of hemodialysis charges to be paid at the Business Office.
- Once payments are made, a clearance slip will be issued by the cashier.
This must be given to the dialysis nurse on duty before hemodialysis is
started.
Particular to company-sponsored patients:
Referral to the renal unit for the charges won't be necessary as these will
be forwarded to the Business Office along with the Letter of Authorization
(LOA) issued by the company.
B.O. clearance for hemodialysis is entirely different from clearance before
surgery (e.g. shunt insertion), therefore, these should be facilitated separately.
Please don't leave out proper pre-dialysis endorsement.
- Laboratories to be taken pre & post hemodialysis
- Medicines pre & post hemodialysis
- Blood transfusion - must be properly secured and crossmatched
B. Out-patients
All patients for hemodialysis must be referred officially to the Director
of the Kidney Service.
Dialysis privileges granted to other physicians will be the sole discretion
of the Director of the Kidney Service. These are granted on a case to
case basis. When the privilege is granted, a professional fee will still be
charged by the Kidney Service.
Schedules for hemodialysis will be posted at least one day prior to the
schedule of the procedure.

The unit staff should be immediately notified of any cancellation or

delay of a scheduled procedure.
Written consents should be secured for:
- Each dialysis
- Femoral vein catheterization
- First re-use of dialyzer
Note: The consent should be signed by the patient, parents
(if the patient is a minor), relative or person responsible
for the patient.
The dialysis nurse, technician and aide should prepare for the
procedure at least one hour prior to schedule.
PSH Kidney Service reserves the right to refuse any patient for dialysis
when the safety of the dialysis personnel and/or other patients, or the
stability of the unit is threatened.