PhilHealth Annex M: Breast Cancer Medical Records Summary Form
Fill PhilHealth Annex M: Breast Cancer Medical Records Summary Form 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: Last Name, First Name, Middle Name, Suffix, PhilHealth ID Number, Laterality of breast cancer, Biopsy Histological Diagnosis (Verbatim from histopathology report), Date (mm/dd/yyyy), Clinical Cancer Stage at pre-authorization, What is T?, What is N?, What is M?, Widest diameter size of primary tumor (cm), Widest diameter size of primary tumor (mm), Skin ulceration.
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.