PhilHealth Annex G: Checklist for Patient Transfer
Fill PhilHealth Annex G: Checklist for Patient Transfer 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, Middle Name, Suffix, 2. PhilHealth ID Number, Updated Medical Abstract, Name and Signature Attending Physician, Letter of Referral from the Attending Physician, Certified true copy of the breast cancer treatment passport, Name and Signature Patient/Parent/Guardian, Certified complete by, Date signed (mm/dd/yyyy), Conforme by.
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.