PhilHealth Annex "E – Prostate CA”
Fill PhilHealth Annex "E – Prostate CA” 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, HEALTH CARE PROVIDER (HCP), ADDRESS OF HCP, 1. Last Name, First Name, Middle Name, Suffix, 2. PhilHealth ID Number, Same as patient, 2. Photocopy of Approved Pre –Authorization Checklist & Request, 4. Properly accomplished PhilHealth Claim Form 1 (CF1) or PhilHealth Benefit, 7. Photocopy of accomplished surgical operative report, 8. Photocopy of accomplished anesthesia report, Certified correct by, Conforme by.
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