Document

Validity Conditions

1. Original Endorsement Letter from the Service Provider addressed to OVP, signed by the Medical Social Worker

• Signed and addressed to OVP
• Contains contact details of the Service Provider and Medical Social Worker
• If the endorsement is from a Service Provider that does not have a MOA with OVP, the endorsement letter should also contain the Service Provider’s bank account details
• Dated not more than six (6) months prior to the date of the interview

1. Original Application Form, filled-up and signed by the Client and/or authorized representative (if applicable)

• Dated and signed
• Complete details with legible writing/text

Medical Assistance Application Form: Download Form

1. Social Case Study Report or Barangay Certificate of Indigency (Original or Certified True Copy)

• Dated and signed by the licensed social worker not more than one (1) year prior to the date of the interview
• May be addressed to OVP, other government agencies, or any acceptable generic alternative

1. Medical Records (Original or Certified True Copy)

e.g., Clinical Abstract, Medical Certificate

• Signed by the attending physician with license number indicated in the medical record
• Dated not more than six (6) months prior to the date of the interview

1. Photocopy of one (1)valid Identification Card (ID) of:

• Client
• Representative, if applicable

• Valid as of the date of the interview
• Listed by PAD as an acceptable ID
• Front and back of the card were photocopied
• Original must be presented for verification

List of Valid IDs:

Alternative IDs for Minors:

- Registered Birth Certificate (with Registry Number)

- School ID (currently enrolled)

- Barangay ID

- Service Issue Card from the Service Provider

A barangay certificate or any other alternative proof of identity may be accepted if an ID is not a viable option due to the circumstances of the Client (e.g., newborn, indigenous peoples).

Case Type

Document and Validity Conditions

Chemotherapy / Radiation Therapy / Brachy Therapy

• Treatment Protocol with cost breakdown issued by the attending physician with the following validity conditions:

• Signed by the physician with license number
• Dated not more than six (6) months prior to the date of the interview

Operation / Surgery / Transplant

• Estimated cost of operation issued by the attending physician with the following validity conditions:

• Signed by the physician with license number
• Dated not more than six (6) months prior to the date of the interview

Hospitalization

• If confined, the latest Statement of Account dated not more than six (6) months, signed by the billing or accounting officer
• If discharged, latest Statement of Account andPromissory Note signed by the hospital and the Client both dated not more than six (6) months prior to the date of the interview and duly signed by the authorized accounting or credit collection officer

Hemodialysis

• Price Quotation per session excluding the cost of dialyzer and professional fees dated not more than six (6) months prior to the date of the interview

Implant (General)

• Price Quotation signed and dated not more than six (6) months prior to the date of the interview

Laboratory / Diagnostic Procedure

• Request letter issued by the attending physician with the following validity conditions:

• Dated not more than six (6) months prior to the date of the interview
• Signed by the physician with license number

• Quotation from hospital or clinic where the procedure will be undertaken

Medicines

• Prescribed medicines issued by the attending physician with the following validity conditions:

• Signed by the physician with license number and contact details
• Dated not more than six (6) months prior to the date of the interview

• Price Quotation from a drug store (Globo Asiatico or South Star Drug)