PhilHealth Annex “ A – RF/RHD ”
Fill PhilHealth Annex “ A – RF/RHD ” 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 INSTITUTION (HCI), ADDRESS OF HCI, 1. Last Name, First Name, Middle Name, Suffix, 2. PhilHealth ID Number, Fulfilled selections criteria, If no, specify reason/s and encode, Stage, Echocardiogram finding (tick one, whichever is applicable), Date/s of 2D-echo, Treatment Plan: choose one, Choose one.
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.