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Patient Details

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Patient Screening Form

INTRODUCTION

Makati Medical Center ensures the safety of its patients, employees, visitors and the community by identifying high-risk patients and medical staff managing them accordingly.

In compliance with RA 11332 Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act, it is essential that you provide truthful information about your health condition and possible exposure. The collected data indicated herein is for the purpose of contact tracing to control COVID-19 transmission. The records will be retained in Makati Medical Center and will be destroyed after 30 days from the date of accomplishment, following the National Archives of the Philippines Protocol and Joint Memorandum 20-04 Series of 2020 DTI and DOLE Supplemental Guidelines on Workplace Prevention and Control of COVID-19.

Please fill-out this form at least 24 hours before your scheduled appointment. After you fill-out the form, you will receive an email confirmation detailing your next steps with a PDF copy of the Patient Screening Form. Please print or save the PDF copy and show the copy during your visit.

Validity: This screening form will be valid for five (5) days. Any symptom which may develop or any unprotected exposure within this coverage period for the Patient will automatically invalidate this initial screening session. The Patient should accomplish a new screening form.

Reminders:
  • NO Patient Screening Report NO Entry
  • NO Mask NO Entry
  • NO Face Shield NO Entry (Face shield should cover the whole face, visor types are not allowed)
  • Allow time for thermal scanning and validation of Patient Screening Report
  • Observe social distancing at all times
  • Come Approximately 20 minutes before your procedure
  • Only one (1) companion is allowed per patient (with his/her own companion Screening Report)
  • NO Companion Screening Report NO Entry


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Abelardo, Nelson

Cardiology

M W F

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Bolanos, Martha

Neurology

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Castillo, Celia

Internal Medicine

M T W TH F

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Chua, Vic Fileto

Internal Medicine, Geriatrics

T TH S

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Chua, Alberto

Internal Medicine, Nephrology

M T W TH F S

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De Castro, Aida

Internal Medicine

M T W TH F

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Dizon, Alfred

Occupational Medicine

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Dueñas, Christine

Pediatrics

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Esguerra, Denise Francesca

Gastroenterology, Internal Medicine

M T W TH F S

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Lim, Rosie

Cardiology, Internal Medicine

T TH S

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Oco-Panganiban, Michelle

Family Medicine, Occupational Medicine

M T W TH F S

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Ong-Go, Mary

Cardiology, Internal Medicine

M W F


Select date and time based on doctors availability


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