PhilHealth Annex E: Letter of Intent for Transfer of PD Care
Fill PhilHealth Annex E: Letter of Intent for Transfer of PD Care 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: DATE (mm/dd/yyyy), PATIENT (Last name, First name, Middle name, Suffix), PHILHEALTH ID NUMBER OF PATIENT, MEMBER (if patient is a dependent) (Last name, First name, Middle name, Suffix), PHILHEALTH ID NUMBER OF MEMBER, (Name of Patient), (Date of Birth), (Address), (indicate number), (Name of Nephrologist), (Printed name and signature), PhilHealth Accreditation.
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.