PhilHealth Annex A.1: Pre authorization Checklist and Request for Hip Arthroplasty
Fill PhilHealth Annex A.1: Pre authorization Checklist and Request for Hip Arthroplasty 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, Fulfilled selections criteria, SITE OF INJURY, SURGICAL URGENCY, Emergency: Date of surgery (mm/dd/yyyy), Ambulatory prior to injury, Normal or with mild systemic disease or no functional limitation (ASA I & II), Hip fracture: (tick appropriate description), with avascular necrosis of the femoral head, Neglected fracture of the hip.
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.