PhilHealth Annex B: Certificate Of Renal Replacement Therapy Add -on Service For Patients With
Fill PhilHealth Annex B: Certificate Of Renal Replacement Therapy Add -on Service For Patients With 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: DATE (mm/dd/yyyy), PATIENT NAME (Last name, First name, Middle name, Suffix), Home Address, PHILHEALTH ID NUMBER, Last Name, First Name, Middle Name, Hospital Name, Date of Admission: Month/Day/Year, Signature over Printed Name, Date Signed (mm/dd/yyyy), PhilHealth Accreditation No.
The form is the agency's own, from philhealth.gov.ph (checked 2026-10-14): the PDF you download is that form with your values printed in its boxes.
The free clean PDF is that pack’s shortest form. A later form in the same pack needs the Starter plan (₱499) or above. Preview, check, and verify stay free. Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.