MIHMCI RT-PCR Appointment

Online Registration Form

Advisory! Please download the CIF Form & Waiver Form after registration, please fill up forms and show it to our personel at MIHMCI for faster transaction.

Please write legibly and make sure the data provided is true and correct. These data are sent to DOH as part of mandatory reporting of covid laboratories.

1. Personal Information:
First Name:
Middle Name:
Last Name:
Suffix:
PHIC Number:
Gender:
Status:
Nationality:
Occupation:
Birthdate:
Year
Month
Day
Date of RT-PCR Test:
Year
Month
Day
2. Philippine Residence:
Current Address
House No./Lot/Bldg.:
Street/Purok:
Brgy:
Municipality/City:
Province:
Home Phone:
Cellphone #:
E-mail (For Result):




Permanent Address: (Check if same with Current Address):
House No./Lot/Bldg.:
Street/Purok:
Brgy:
Municipality/City:
Province:
Home Phone:
Cellphone #:
E-mail (For Result):




Current Workplace Address:
House No./Lot/Bldg.:
Street/Purok:
Brgy:
Municipality/City:
Province:
Name of workplace:
Cellphone #:
E-mail (For Result):
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