PhilHealth Annex F: Checklist of Requirements for Reimbursement
Fill PhilHealth Annex F: Checklist of Requirements for Reimbursement 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 (Answer only if the patient is a dependent), 2. Photocopy of the MDT Plan, 5. Properly Accomplished PhilHealth Claim Form 2 (CF2), 8. Checklist of Requirements for Reimbursement (Annex F), 10. Transmittal Form (Annex I), 13. Photocopy of Anesthesia Record or similar documents, Date Completed (mm/dd/yyyy), Date Filed (mm/dd/yyyy), Certified correct.
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.