PhilHealth Annex L.3: Checklist of Requirements for Reimbursement – Tranche 1
Fill PhilHealth Annex L.3: Checklist of Requirements for Reimbursement – Tranche 1 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, 6. Photocopy of the Mental Health Passport (Annex D), 7. Original or Certified True Copy (CTC) of the Statement of Account, Certified correct by, PhilHealth Accreditation No, Date signed (mm/dd/yyyy), Conforme by.
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