PhilHealth Annex E.2: Checklist of Requirements for Reimbursement - Premature Small Baby
Fill PhilHealth Annex E.2: Checklist of Requirements for Reimbursement - Premature Small Baby 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: Registry No, 1. Last Name, First Name, Middle Name, Suffix, 2. PhilHealth ID Number, 2. Checklist of Requirements for Reimbursement (Annex E.2 - Premature or, 5. Copy of the Checklist of Eligibility Criteria (Annex A), 6. Checklist of Mandatory and Other Services (Annex C.2 - Premature or Small, 9. Original or certified true copy (CTC) of the Statement of Account (SOA), 11. Copy of Essential Intrapartum Newborn Care (EINC) Protocol Checklist, DATE COMPLETED (mm/dd/yyyy), DATE FILED (mm/dd/yyyy), (Printed name and signature), PhilHealth Accreditation No.
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