Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Citystate Centre, 709 Shaw Boulevard, Pasig City
Call Center (02) 441-7442 Trunkline (02) 441-7444
www.philhealth.gov.ph

Negative List (Members/Dependents with Deficiencies in Eligibility)

01/29/2019

Name of PCB Provider CANDELARIA MUNICIPAL HOSPITAL

RHU Accreditation Number P41026002
2016

Member PhilHealth Suffix Date of Mem

No. Last Name First Name Middle Name SexCategory Date Enlisted Date Profiled
ID # Name Birth Category
080260285045 AMAR DARLYN FASONILAO 07/01/1984 MM DEPED 07/04/2016 (U) 07/05/2016 (U)
1 (Q3) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS
080000295209 ATACADOR ARNELIE PANEZAREZ 08/30/1975 MM DEPED 04/19/2016 (U) 04/19/2016 (U)
2 (Q3,Q4) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS
190006218966 ATIENZA EVANGELINE DE CASTRO 11/03/1972 MM DEPED 04/20/2016 (U) 04/20/2016 (U)
3 (Q2,Q3,Q4) Duplicate and/or multiple PINs
080000517651 BECINA GRETCHEN CARINGAL 11/30/1977 MM DEPED 04/07/2016 (U) 04/07/2016 (U)
4 (Q2,Q3,Q4) Duplicate and/or multiple PINs
2016051300186 BELARMINO JUVY ZALDUZ 01/01/1970 NM 05/13/2016 (U) 05/13/2016 (U)
5 Not a PhilHealth member/dependent
2016051600198 BISCHOCO IVY ALVIAR 08/14/1983 NM 05/16/2016 (U) 05/16/2016 (U)
6 Not a PhilHealth member/dependent
080251160787 CASTILLO MIDELIZA PUNZALAN 04/15/1981 MM 05/05/2016 (U) 05/05/2016 (U)
7 (Not specified)

080504554590 COMIA EVELYN BARCELONA 02/12/1977 MM 05/16/2016 (U) 05/13/2016 (U)

8 ()
080256717119 DALISAY JASMINE KAE MERAÑA 10/14/1991 MM DEPED 04/05/2016 (U) 04/05/2016 (U)
 9 Member PhilHealth Last Name
No. First Name Middle Name
Suffix Date of
SexCategory
Mem
Date Enlisted Date Profiled
ID # Name Birth Category
(Q3) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS

080253602108 DE ALDAY ERIKA MARIE TAYAG 02/24/1990 MM 05/17/2016 (U) 05/17/2016 (U)
10 (Not specified)

080001017962 DELA CRUZ RONALYN ARAZO 09/10/1983 MM DEPED 04/19/2016 (U) 04/19/2016 (U)
11 (Q2,Q3,Q4) Duplicate and/or multiple PINs
2016051700186 DESCALSOTA LETICIA CERIA 06/01/1955 NM 05/17/2016 (U) 05/17/2016 (U)
12 Not a PhilHealth member/dependent

080000571923 DIMAYACYAC MYRNA MARASIGAN 07/07/1980 MM DEPED 04/07/2016 (U) 04/07/2016 (U)
13 (Q2,Q3,Q4) Duplicate and/or multiple PINs
082005023609 DOMINGO LERMA MERLE 01/23/1983 MM 05/06/2016 (U) 05/06/2016 (U)
14 (Not specified)

080258743168 EMPALMADO KAREN LYNN TOLENTINO 06/21/1990 MM DEPED 04/05/2016 (U) 04/05/2016 (U)
15 (Q3,Q4) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS
080510914434 FORNIL JENNYLYN MARASIGAN 05/13/1989 MM DEPED 04/07/2016 (U) 04/07/2016 (U)
16 (Q2,Q3) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS

080253747653 GONZAGA NOIMIE VILLENA 07/28/1990 MM 05/12/2016 (U) 05/12/2016 (U)

17 (Not specified)
080510668093 GUDOY MARILYN CALAGUAN 10/25/1983 MM 06/11/2016 (U) 06/11/2016 (U)
18 (Not specified)

2016051700600 GUICO ELENA DURANA 05/03/1971 NM 05/17/2016 (U) 05/17/2016 (U)

19 Not a PhilHealth member/dependent
2016051300124 IGLESIA BENJAMIN RUAN 01/01/1970 NM 05/13/2016 (U) 05/13/2016 (U)
20 Not a PhilHealth member/dependent

080000285068 MACATANGAY MARINA SANTIAGO 07/18/1955 MM DEPED 04/12/2016 (U) 04/12/2016 (U)
21 (Q2,Q3,Q4) Duplicate and/or multiple PINs

080510429889 MAGADIA GRACE ARELLANO 12/11/1988 MM 05/17/2016 (U) 05/17/2016 (U)

22 (Not specified)
080513102619 MANATIGA JOVELYN REY LIBRADILLA 01/20/1993 MM 05/12/2016 (U) 05/12/2016 (U)
 Member PhilHealth Suffix Date of Mem
No.
23 Last Name First Name Middle Name SexCategory Date Enlisted Date Profiled
ID # Name Birth Category
(Not specified)

201605160003 MARCIANO GLORILYN GOZO 07/08/1979 NM 05/16/2016 (U) 05/16/2016 (U)

24 Not a PhilHealth member/dependent

080250787565 MARCIANO GLORILYN GOZO 08/07/1979 MM DEPED 04/05/2016 (U) 04/05/2016 (U)
25 (Q4) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS
190007246815 MENDOZA JANICE DE CASTRO 10/18/1979 MM DEPED 04/26/2016 (U) 04/26/2016 (U)
26 (Q2,Q3,Q4) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS

090502055967 NAVARRO MARIA CELESTE CUETO 11/13/1975 MM 05/13/2016 (U) 05/13/2016 (U)
27 (Not specified)

080513386641 PORCIONCULA AILEEN DELOS REYES 04/17/1991 MM 05/16/2016 (U) 05/16/2016 (U)
28 (Not specified)

2016051700150 RAMOS NELIA CRISOGONO 07/18/1972 NM 05/17/2016 (U) 05/17/2016 (U)

29 Not a PhilHealth member/dependent
190002647757 REYES REMEDIOS LOPEZ 10/12/1958 MM DEPED 06/11/2016 (U) 06/11/2016 (U)
30 (Q2,Q3,Q4) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS

080505964423 SANGALANG SARAH MACANOQUIT 06/23/1971 MM DEPED 04/21/2016 (U) 04/21/2016 (U)
31 (Q2) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS

080000567748 SILVA NORIE MONTIFAR 12/20/1974 MM DEPED 04/11/2016 (U) 04/11/2016 (U)
32 (Q2,Q3,Q4) NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS

19000304529701 UMALI ADELAIDA V 12/16/1940 DD DEPED 06/11/2016 (U)

33 (Q4) Subject to validation by PhilHealth
080000865242 VERGARA MYLENE ROSARIO 03/21/1984 MM DEPED 04/21/2016 (U) 04/21/2016 (U)
34 (Q2,Q3,Q4) Duplicate and/or multiple PINs

080506683738 ZARA NIÑA ROSALIE VERGARA 08/19/1983 MM 05/13/2016 (U) 05/13/2016 (U)
35 (Not specified)
 Republic of the Philippines
PHILIPPINE HEALTH INSURANCE CORPORATION
Citystate Centre, 709 Shaw Boulevard, Pasig City
Call Center (02) 441-7442 Trunkline (02) 441-7444
www.philhealth.gov.ph

Masterlist

01/29/2019

Name of PCB Provider CANDELARIA MUNICIPAL HOSPITAL

RHU Accreditation Number P41026002
SAP Number: BT2016Q2Z02622F
Q2 of 2016

No. Member PhilHealth ID # Last Name First Name Middle Name Suffix Name Date of Birth Sex Category Date Enlisted Date Profiled

SAP Number: BT2016Q3Z02622E

Q3 of 2016

No. Member PhilHealth ID # Last Name First Name Middle Name Suffix Name Date of Birth Sex Category Date Enlisted Date Profiled

SAP Number: BT2016Q4Z02622D

Q4 of 2016

No. Member PhilHealth ID # Last Name First Name Middle Name Suffix Name Date of Birth Sex Category Date Enlisted Date Profiled
 Statement of Accounts Payable (SAP)

PhilHealth Regional Office : PRO IV-A Lucena City SAP Reference Number : P41026002-2019011618190851441
Health Care Institution Name : CANDELARIA MUNICIPAL HOSPITAL SAP Period : 2nd to 4th Quarter 2016
CANDELARIA, QUEZON

ENLISTED PROFILED
TOTAL QUALIFIED ENLISTMENT FEE TOTAL QUALIFIED TOTAL
Profile PROFILE FEE AMOUNT
QUARTER SAP Numbers
Member Dependent Current Previous Member Dependent Rate Current Previous
Member Dependent Member Dependent (c-d)+(h-i)
(a) (b) (c=a*50.00) (d) (e) (f) (g) (h=a*g) (i)
1st - - - - - - - - - - - - - -
2nd BT2016Q2Z02622F 330 2 289 2 14,450.00 14,450.00 615 - 287 - 75.00 21,675.00 21,675.00 -
3rd BT2016Q3Z02622E 331 2 287 2 14,350.00 14,350.00 616 - 286 - 75.00 21,525.00 21,525.00 -
4th BT2016Q4Z02622D 331 2 290 1 14,500.00 14,500.00 619 - 289 - 75.00 21,750.00 21,750.00 -
NOTES: The total number of qualified enlisted refers only to all enlisted member eligible for payment..
The total number of qualified profiled refers only to all member eligible for payment
The '*' after the SAP Number indicates that the SAP has already been vouchered by PhillHealth. Date Generated: 1/17/2019 6:14:56 PM
Amounts shown may represent computations for partial payment and still subject for adjustments.

Prepared by: Approved by:

Nurse/Midwife Head of HCI
(Signature over Printed Name) (Signature over Printed Name)

This is to certify that I have reviewed this statement of accounts payable based on submitted documents and hereby recommend for payment as billed.

LHIO Head
(Signature over Printed Name)

Date