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Updated Medical Referral Slip

This document is a pre-employment medical examination referral slip for Davies Vega Viñas, who is applying for a position at Ingram Micro. It provides his personal details like name, birthdate, age, sex, and contact information. It also lists two package options for his pre-employment medical examination - a basic package with drug test screening for shabu and marijuana, or an expanded package screening for additional drugs like cocaine and morphine. The bottom of the document lists contact information for several MyHealth clinic locations where the examination can take place.

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Mom-c PS
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387 views2 pages

Updated Medical Referral Slip

This document is a pre-employment medical examination referral slip for Davies Vega Viñas, who is applying for a position at Ingram Micro. It provides his personal details like name, birthdate, age, sex, and contact information. It also lists two package options for his pre-employment medical examination - a basic package with drug test screening for shabu and marijuana, or an expanded package screening for additional drugs like cocaine and morphine. The bottom of the document lists contact information for several MyHealth clinic locations where the examination can take place.

Uploaded by

Mom-c PS
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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www.myhealth.

ph

PRE-EMPLOYMENT MEDICAL EXAMINATION REFERRAL SLIP

Patient’s Name:
D A V I E S V E G A V I Ñ A S

Company Name: INGRAM MICRO

Birthdate: SEPTEMBER 10, 1999 Age: 2 3 Sex: M A L E

Address: # 3 4 9 4 G e n e r a l S a n t o s A v e . P r k . 6 A L o w e r B i c u t a n , T a g u i g C i t y

Contact No: 0 9 9 5 4 6 9 4 2 7 0

PRE-EMPLOYMENT MEDICAL PACKAGES

PACKAGE 1: PACKAGE 2:

BASIC 5 WITH DRUG TEST BASIC 5 WITH DRUG TEST

1 COMPLETE PHYSICAL 1 COMPLETE PHYSICAL


EXAMINATION EXAMINATION

2 COMPLETE BLOOD COUNT 2 COMPLETE BLOOD COUNT

3 URINALYSIS 3 URINALYSIS

4 CHEST X-RAY (PA) (results in CD) 4 CHEST X-RAY (PA) (results in CD)

5 DRUG TEST: SHABU & MARIJUANA 5 DRUG TEST: SHABU, MARIJUANA,


COCAINE & MORPHINE
*Note: If Morphine is not
available, please proceed with 3
panels instead

JAYSON MATUGUINAS

AUTHORIZE SIGNATURE PATIENT’S SIGNATURE


www.myhealth.ph

CLINIC BRANCHES

MyHealth Clinic – Venice Grand Canal Mall


nd
2 Level Venice Grand Canal Mall, McKinley Hill, Taguig City
Clinic Hours: Open 24/7

MyHealth Clinic – Quezon City


nd rd
2 and 3 Level, Northlink Building, SM City North EDSA

MyHealth Clinic – Mandaluyong


Ground Floor, Unit 146, Level 1, Shangri-la Plaza Mall

MyHealth Clinic – Muntinlupa


nd
2 Level, Style Boulevard, Festival Supermall, Alabang

MyHealth Clinic – Manila


4th Floor, Pedro Gil Wing, Robinsons Place Manila

MyHealth Clinic – Cybergate Cebu


rd
3 Level, Robinsons Cybergate Mall Cebu

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