PhilHealth Annex “ C 2.1 – Visual Disabilities ”
Fill PhilHealth Annex “ C 2.1 – Visual Disabilities ” 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, PATIENT (Last name, First name, Middle name, Suffix), PHILHEALTH ID NUMBER OF PATIENT, PHILHEALTH ID NUMBER OF MEMBER, Optical aid 1: Low power distance, category 1, Optical aid 2: High power distance,, Optical aid 3: colored filter, category 1, Ocular prosthesis, Printed name and signature, PhilHealth Accreditation No.
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.