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  • Ph Sss Med-01688 2022

Get Ph Sss Med-01688 2022-2025

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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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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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232