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  • Ph Sss Med-01688 2022

Get Ph Sss Med-01688 2022-2026

Republic of the Philippines SOCIAL SECURITY SYSTEM MEDICAL CERTIFICATE SSS FORM MMD - 102 1. EMPLOYEE S GENERAL DATA NAME Last First M.I. AGE SEX CIVIL STATUS OCCUPATION DATE EXAMINED/ATTENDED To From 2. BRIEF CLINICAL HISTORY AND PRESENT PHYSICAL FINDINGS Attach extra sheet if needed 3. X-RAY LABORATORY AND/OR SPECIAL DIAGNOSTIC EXAMINATION Attach extra sheet if needed 4. FINAL DIAGNOSIS 5. EXACT DATE OF DISABILITY 6. KIND OF SURGICAL OPERATION PERFORMED IF ANY If claim is for disability attach operating room record 7. DATE OF OPERATION 8. PERIOD OF MEDICAL ATTENDANCE/ TREATMENT/ACTUAL SICKNESS CONVALESCING OR RECUPERATION PERIOD PLACE OR PLACES WHERE THE PATIENT WAS CONFINED DURING MY MEDICAL ATTENDANCE AND/OR TREATMENT PLACE/S OF CONFINEMENT DATE FROM TO 9. OTHER REMARKS PURSUANT TO SECTION 28 OF THE SOCIAL SECURITY LAW AS AMENDED ANYONE WHO RESORTS TO MISREPRESENTATION OR CONCEALMENT OF A MATERIAL FACT OR WHO IS A PARTY THERETO FOR THE PURPOSE OF CAUSING ANY PAYMENT OF FRAUDULENT C....

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  2. Begin by entering your personal information in the designated fields. This includes your full name, date of birth, and identification number. Ensure that all entries are accurate and match official documents.
  3. Complete the contact information section. Provide a valid email address and phone number where you can be reached for any follow-up inquiries.
  4. Fill out the details regarding your medical condition as prompted. Be as specific as possible, detailing your diagnosis and any relevant medical history.
  5. Review any additional requirements that may need to be submitted alongside the form. This could include medical records or certificates from healthcare providers.
  6. Double-check all the information provided to ensure correctness. It is vital to avoid errors that could delay processing your request.
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THIS CAN ALSO BE DOWNLOADED THRU THE SSS WEBSITE AT .sss.gov.ph PLEASE READ THE INSTRUCTIONS AND REMINDER AT THE BACK BEFORE FILLING OUT THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS AND USE BLACK INK ONLY.

A member is qualified to avail of this benefit if he/she: Is unable to work due to sickness or injury and is confined either in a hospital or at home for at least four (4) days; Has paid at least three (3) months of contributions within the 12-month period immediately preceding the semester of sickness or injury;

MED-01688 (06-2022) Republic of the Philippines. SOCIAL SECURITY SYSTEM. MEDICAL CERTIFICATE.

Registration and Membership Forms PPS-KUR Kasambahay Unified Registration Form. E-4 Member Data Change Form. NW-1 Non - Working Spouse Record. E-1 Personal Record Form. Unified Multi-Purpose ID Card Application Form.

You must fill up Form RS-5 using black ink and submit it in three copies to any SSS-accredited bank or to the Cashiering Department at the SSS Head Office at East Avenue, Diliman, Quezon City, together with your payment.

(SSS FORM MMD - 102)

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