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

Service Provider

Applicant/
Client

Duration of Activity
(Under Normal
Circumstances)

Person-in-Charge

Fees
(Services are
rendered free of
charge)

Forms Needed

Not Applicable

Prescribed
documentary
requirements

STAGE 1: Evaluation of Application (Day 1)

Submit all
documentary
requirements.

A.

Reviews requirements
under the IMAP guidelines

A1. For cases with complete

documents (With
appointment and New
cases)

Officer-of-the-Day (OD)
Juanito Hermancio
Mariquita Reyes
Josephine Zafra
Jose Osorio
3 minutes per case

IMAP Application Form

- Attaches application forms for
those with complete
documents.
Note: Priority lane for Senior
Citizen and Person With
Disability (PWD)
Requirements checklist
A2. For cases with
incomplete document
and without appointment

Endorsement letter
Referral Letter

- Provides checklist/ orients

client with needed
requirement.
- Endorses cases for medical
evaluation (for request of
medicines, chemotherapy,

5 minutes per case

diagnostic and laboratory

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

Schedule slip
- Prepares referral for price
quotation (for laboratory,
diagnostic procedures,
radiotherapy, implants, hearing
aids and other requests
requiring official quotation)
- Schedules cases for interview

Fill-up the
application
form

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

2 minutes per case

Wait for the assigned SW to

be flashed in our
monitor/screen

Volunteer

Not Applicable

Interview phase
proceed to
the assigned
SW

Interviews, assesses and

classifies request and prepares
recommendation/SCSR

20 minutes per case

Reviews, confirms and affixes

signature in the
recommendation (SCSR)

Not Applicable

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

Issues claim slip and advise

client to comeback on the
specified date for the release
of guarantee letter.

Social Workers (SW)

3 minutes per case

Supervisor

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

Not Applicable

Marivic Llanes
Maricar Santos
Leslee Deabanico
Lilibeth Javier

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

- Encodes transmittal of cases

for approval
- Prepares guarantee letters
(GL)

- Reviews and affix signature in

the GL

2 minutes per case

Encoder

2 minutes per case

(Day 2)

Gina Balde
(Supervisor)
Elizabeth Lompot
Ursula Aguilar
Bernard Romero

2 minutes per case

(Day 2)

Division Chief III

Herminia B. Reyes
or her authorized

Not Applicable

Not Applicable

Guarantee Letter

representative
8

- Approves cases not 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

- Approves cases not more than

P200,000.00

2 minutes per case

(Day 4)

Asst. General Manger

Not Applicable

- Approves cases more than

P200,000.00

2 minutes per case

(Day 6)

General
Manager/Chairperson

Not Applicable

- Recommends cases more than

P100,000.00

10

11

- Receives and data bank

approved IMAP cases

2 minutes per case

(Day 4 for cases
P200,000.00 and below)

Releasing Section

Not Applicable

Aida Tizon
(Supervisor)

(Day 7 for more than

P200,000.00 upon approval
of authorized signatory

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

Releasing of Guarantee Letters

Step

Applicant/Client

Submits claim slip

Wait while the

guarantee letters are
being retrieved/located.

Service Provider

Accepts and reviews claim slip

- Locates and retrieves

approved guarantee letters.

Duration of Activity
(Under Normal
Circumstances)

Person-in-Charge

Fees

Forms Needed

1 minute per case

Releasing Section

Not Applicable

Claim Slip

6 minutes per case

- Dry-seal the approved

guarantee letters

Aida Tizon
Nancy Filart
Florida Dela Torre
Allan Domingo
Ronald Magada
Rommel Azucena

Not Applicable

- If the guarantee letters are not

yet available, inform the client
that it is not yet available.
3

When the patient name

is called, present valid
ID

- Validates the identity of the

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

Receive the approved

guarantee letters

- 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