Requirements for Medical and Surgical Assistance

 

RF: 000118-2017

 July 17, 2017

 

TO:       VOLUNTEER DOCTORS                                                 

            PARTNER HOSPITALS

            PARTNER INSTITUTIONS

 

FROM:  MCCCI MEDICAL COMMITTEE

 

               SUBJECT:   MCCCI PATIENT ASSISTANCE PROCESS

 

The Masonic Charities for Crippled Children, Inc. (MCCCI) in its continuing pursuit in providing hope for our differently abled children is ready to accept endorsed patients guided by the process below:

 

  1. Patient must be sponsored by a Freemason endorsed by the Worshipful Master and/or Lodge Secretary within his jurisdiction.
  2. Accomplished form (Form 101-A and Form 101-B) and other related documents can be directly submitted  to MCCCI office or GLP Secretariat.
  3. MCCCI medical committee (Medcom) will review and assess the endorsed patient/s.
  4. MCCCI will endorse the patient/s to its affiliated hospitals, partner doctors for medical evaluation (Diagnosis and procedure cost estimates).
  5. Medical evaluation report shall be reviewed and approved by the MCCCI Medcom for funding and hospital endorsement.
  6. Only approved Patient/s shall be endorsed for medical procedure.
  7. Hospital will bill MCCCI for the medical expenses after the procedure.
  8. MCCCI will keep track the condition of the patient until recovery.

 

 

 

For your information and guidance.

 

Sincerely,

BRO. DR. ALFONSO A. VILLAROMAN, MD, FPCAM

Medical Director

 

Noted by: 

VW EFREN T. ARAYATA, JR.

Corporate Secretary

 

Approved by: 

MW ABRAHAM N. TOLENTINO

Chairman

 

 

 

 

 

The following are requirements on Application for Treatment:

  1. Accomplished Application Form and Waiver Form (click to download);
  2. Birth Certificate (Photocopy);
  3. Pictures showing deformities/ illness (at least 3);
  4. Barangay Certificate of Indigence;
  5. DSWD Certificate of Indigence and/or Case Study Report;
  6. PhilHealth ID Card (Photocopy) and Member Data Record (indicating that applying patient for treatment is one of the beneficiaries);
  7. Medical Abstract, Laboratory etc., (if available):
  8. Endorsement of a Lodge (signed by Worshipful Master and/or Secretary);

Additional requirements:

  1. Initial Examination, Recommendation, Cost Estimate by MCCCI Medical Director or Accredited Specialist;
  2. Approval of the Board of Trustees;
  3. Post-operation photos must be submitted after treatment.