PhilHealth Annex G.1B: Checklist of Requirements For Reimbursement - Exit Site Infection
Fill PhilHealth Annex G.1B: Checklist of Requirements For Reimbursement - Exit Site Infection 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, Accomplished Checklist of Requirements for Reimbursement, Accomplished Checklist of Essential Health Services for Exit Site, Original or Certified true copy (CTC) of the Statement of Account, Date Completed (mm/dd/yyyy), Date Filed (mm/dd/yyyy), Certified correct by:*, PhilHealth Accreditation No, Date signed (mm/dd/yyyy).
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