Online HMO Approval
Online HMO Approval
PATIENT DETAILS
Name
*
*Should match valid ID & HMO Card
Date of Birth
*
Gender
Select Gender
Female
Male
*
Contact Number
*
Email Address
*
Type of Valid ID
Select Valid ID
Driver's License
Postal ID
SSS ID
GSIS ID
PRC ID
NBI Clearance
Police Clearance
Barangay Clearance
Senior Citizen's ID
ACR I-Card
Consular ID
Permit to Carry Firearms
Passport
Company/Office ID
Student's ID
OFW ID
Seaman's Book
AFP ID
POEA ID
SRRV ID
DSWD ID
OWWA ID
UMID
PNP ID
Voter's ID
*
Valid ID Number
*
Browse...
Upload Valid ID Image
*Please upload images with file type .jpg and .png only.
HMO DETAILS
HMO Card
Select HMO
AsianCare
AsianLife
Avega
BDO Life
BenLife
Caritas
Cocolife
EastWest Healthcare
First Life
Fortune
FWD
Generali
Healthway Mediaccess
HMI
HPPI
IMS Wellth Care Inc
Insular
Intellicare
Kaiser International
Lacson and Lacson
Manulife
Maxicare
MedAsia
MediCard
Medicare Plus
Medilink
MedoCare
Pacific Cross
Phil AXA
Philam Life
PhilCare
Pioneer
PNB Life
Prulife UK
SunLife Financial
ValuCare
*
HMO Card Image
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Upload HMO Card Image
*Please upload images with file type .jpg and .png only.
HMO ID/Policy Number
*
Company Name
*
DOCTOR'S DETAILS
Doctor's Full Name
*
Specialization
*
Doctor's Request
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Upload Doctor Request
*Please note that Doctor Request should have the ff. information
or fill up these fields
*Please upload images with file type .jpg and .png only.
Clinic Address/
Hospital Affiliation
*
Diagnosis
*
MAKE AN APPOINTMENT
HPD Branch
Select HPD Branch
*
*Kindly check our website for the services available in our
branches
Preferred Date of Visit
*
*Some procedures are by appointment only, kindly check our
website for the list of services available in your preferred branch
and call first to schedule an appointment
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1234567890
HI-PRECISION DIAGNOSTICS
DELA CRUZ
JUAN
PID:
00000255
MALE: 26Y DOB: 08-17-92
CASH
PICK-UP
×
1234567890
HI-PRECISION DIAGNOSTICS
DELA CRUZ
JUAN
PID:
00000255
MALE: 26Y DOB: 08-17-92
CASH
PICK-UP
×
1234567890
HPD2(WALK-IN)
DELA CRUZ
JUANA
CH1234567
FEMALE - 25Y DOB: 10-12-93
C - CASH
W - PICK-UP
NONE
REMARKS:
×
1234567890
HPD2(WALK-IN)
DELA CRUZ
JUANA
CH1234567
FEMALE - 25Y DOB: 10-12-93
C - CASH
W - PICK-UP
NONE
REMARKS: