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Medical Assistance Application Form by dalisay.dino is a document available to read on EtoBox.

What is Medical Assistance Application Form about?

The document is a Medical Assistance Form from the Senate Public Assistance Office for a patient named Dalisay Catipon Diño, who is 53 years old and diagnosed with CKD stage 5 due to Diabetes Mellitus type 2. The patient seeks assistance for hospital bills, laboratory tests, and dialysis, with a reported monthly household income of less than 10,000. Required documents for the application include a personal letter to the senator, medical certificates, and proof of indigency.

Author

dalisay.dino

Language

EN