PhilHealth Annex E1.3: Colon Cancer Stage II (high risk) to III – After completion of Chemotherapy
Fill PhilHealth Annex E1.3: Colon Cancer Stage II (high risk) to III – After completion of Chemotherapy 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, Last Name, First Name, Suffix, Middle Name, PhilHealth ID Number, Photocopy of approved Pre –Authorization Checklist & Request, Photocopy of the Multidisciplinary-interdisciplinary Team (MDT) Plan, Original or certified true copy (CTC) of the Statement of Account (SOA), Photocopy of chemotherapy treatment summary form, DATE COMPLETED (mm/dd/yyyy), DATE FILED (mm/dd/yyyy), Certified correct by, Accreditation No, Date signed (mm/dd/yyyy).
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.