PhilHealth Annex C.3: Checklist of Mandatory and Other Services for Chemotherapy
Fill PhilHealth Annex C.3: Checklist of Mandatory and Other Services for Chemotherapy 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, Last Name, First Name, Middle Name, Suffix, PhilHealth ID Number, Neoadjuvant therapy, Z021M11 Doxorubicin/ Epirubicin (A) + Cyclophosphamide (C), Z021N11 Doxorubicin/ Epirubicin (A) + Cyclophosphamide (C), Z021N12 Paclitaxel (Pacli), Adjuvant therapy, Z021M21 Doxorubicin/ Epirubicin (A) + Cyclophosphamide (C), Z021N21 Doxorubicin/ Epirubicin (A) + Cyclophosphamide (C), Z021N22 Paclitaxel (Pacli), Anti-emetic, specify.
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