PhilHealth Annex "E1 – ALL”: Same as patient (Answer the following only if the patient is a
Fill PhilHealth Annex "E1 – ALL”: Same as patient (Answer the following only if the patient is a 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, DATE OF END OF INDUCTION PHASE (mm/dd/yyyy), 1. Checklist of Requirements for Reimbursement (Tranche 1), 2. Photocopy of approved Pre –Authorization Checklist & Request, 5. Checklist of Mandatory and Other Services (Annex C1-ALL), DATE COMPLETED (mm/dd/yyyy), DATE FILED (mm/dd/yyyy).
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.