PhilHealth Annex A.1: Checklist of Eligibility Criteria for Peritoneal Dialysis - Adult
Fill PhilHealth Annex A.1: Checklist of Eligibility Criteria for Peritoneal Dialysis - Adult online and download the official form as a PDF, ready to print. Every input is mapped to its printed box, so IDs, dates and amounts land digit by digit in the right cells, and a value the form cannot hold is refused with the reason instead of being printed wrong.
What you will need: Case No, 1. Last Name, First Name, Middle Name, Suffix, 2. PhilHealth ID Number, PDD Registry No, Date of Registration (mm/dd/yyyy), History of Previous Dialysis Treatment Not Applicable, Date of Last Session (mm/dd/yyyy), With ongoing dialysis session, If yes, indicate the mode of dialysis, 4. No longer uremic, with stable vital signs, 8. Absence of any intra-abdominal tumors or intestinal obstruction, 9. Absence of active serositis.
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