PhilHealth Annex F.1: Checklist of Requirements for Reimbursement - Assessment
Fill PhilHealth Annex F.1: Checklist of Requirements for Reimbursement - Assessment 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, 1. Last Name, First Name, Suffix, Middle Name, 2. PhilHealth ID Number, Same as patient (Answer only if the patient is a dependent), e. Photocopy of the Treatment Plan, g. Original or Certified true copy (CTC) of the Statement of Account (SOA), d. Original or Certified true copy (CTC) of the Statement of Account (SOA), Date Completed (mm/dd/yyyy), Date Filed (mm/dd/yyyy), Certified correct by, PhilHealth Accreditation No, Date signed (mm/dd/yyyy).
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