PhilHealth Annex E: Checklist of Essential Health Services
Fill PhilHealth Annex E: Checklist of Essential Health Services 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, Suffix, Middle Name, 2. PhilHealth ID Number, Same as patient, Assessment, Date of Assessment (mm/dd/yyyy), Physical Medicine and Rehabilitation Specialist/Physiatrist, Physical Therapist, Occupational Therapist, Speech and Language Pathologist (SLPs) or Speech Therapist, Psychologist, Dates (mm/dd/yyyy).
Free to try: 5 forms a day without an account; a free account gets 14 days of clean PDFs, then 25 a month. Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.