PhilHealth Annex C.2: Pre -authorization Checklist and Request Form for other Assistive Mobility
Fill PhilHealth Annex C.2: Pre -authorization Checklist and Request Form for other Assistive Mobility 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, Last Name, First Name, Suffix, Middle Name, PhilHealth ID Number, Same as patient, The patient must be at least 18 y/o and above at the time of, Not Applicable, History of Previous Availment, *If yes, indicate the date of last availment, Specify the type of assistive mobility device, 1. Mild disability in mobility and self-care, 2. No cognitive/ behavioral & communication disability, 3. Inability to do weight-bearing on 1 or 2 lower limbs because.
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.