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University of the Philippines Diliman

University of the Philippines Diliman


List of Documents to be Submitted with eHOPE Application
List of Documents to be Submitted with eHOPE Application

1. Medical Certificate
1. Medical Certificate
2. Clinical Abstract (Medical/Surgical)
2. Clinical Abstract (Medical/Surgical)
3. Hospital Bill/Statement
3. Hospital Bill/Statement
4. Discharge Slip/Clearance
4. Discharge Slip/Clearance
5. Official Receipts (OR) of laboratory/procedures done outside the hospital
5. Official Receipts (OR) of laboratory/procedures done outside the hospital
6. Official Receipts (OR) of Professional Fees (PF) of physicians
6. Official Receipts (OR) of Professional Fees (PF) of physicians
7. Official Receipts (OR) of medicines and medical supplies bought outside
7. Official Receipts (OR) of medicines and medical supplies bought outside
of the hospital
of the hospital
8. Official Receipts (OR) of other expenses being reimbursed
8. Official Receipts (OR) of other expenses being reimbursed
9. For confinement with surgery or hospital procedure:
9. For confinement with surgery or hospital procedure:
9.1 Record or Report of Operation/Procedure
9.1 Record or Report of Operation/Procedure
9.2 Pathology Report (if any)
9.2 Pathology Report (if any)
10. Summary Sheet of Receipts submitted for reimbursement
10. Summary Sheet of Receipts submitted for reimbursement
IMPORTANT REMINDERS:
IMPORTANT REMINDERS:
1. ORs must bear BIR registration of the hospital or company.
1. ORs must bear BIR registration of the hospital or company.
2. Laboratory/special procedure requests must be clearly specified.
2. Laboratory/special procedure requests must be clearly specified.
3. OR of medicines and medical supplies bought outside the hospital must
3. OR of medicines and medical supplies bought outside the hospital must
be accompanied with doctor’s prescription/order.
be accompanied with doctor’s prescription/order.
4. OR of laboratory and other procedures done outside the hospital must be
4. OR of laboratory and other procedures done outside the hospital must be
accompanied with doctor’s order.
accompanied with doctor’s order.
5. Avoid abbreviations of diagnosis in Medical Certificates.
5. Avoid abbreviations of diagnosis in Medical Certificates.
Submitted by: ________________________Contact No.____________________
Submitted by: ________________________Contact No.____________________

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