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primary care benefit 1 - Philippine Health Insurance Corporation

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Letterhead of the Facility<br />

Date:<br />

Providers Agreement Form to Provide the Obligated Services<br />

As Phil<strong>Health</strong>’s participating Primary Care Benefit 1 (PCB1) Package Provider we agree to perform the<br />

obligated services to achieve the targets stipulated below:<br />

BENEFIT/SERVICES IDENTIFIED CLIENTS HOW TO COMPUTE TARGET<br />

(# of<br />

clients)<br />

BP measurement Non‐hypertensive 90 % of the total identified target<br />

clients based on PCB Clientele<br />

<strong>Health</strong> Profile<br />

_____<br />

Periodic clinical breast<br />

examination<br />

Hypertensive<br />

Female, 25 years old<br />

and above<br />

90 % of the total identified target<br />

clients based on PCB Clientele<br />

<strong>Health</strong> Profile<br />

90% of the total identified target<br />

clients based on PCB Clientele<br />

<strong>Health</strong> Profile<br />

_____<br />

_____<br />

Visual inspection with<br />

acetic acid<br />

Female, 25 – 55 years<br />

old with intact uterus<br />

90% of the total identified target<br />

clients based on PCB Clientele<br />

<strong>Health</strong> Profile<br />

_____<br />

___________________________<br />

Printed Name<br />

Head of the Facility<br />

49

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