PhilHealth Waiver for Directly Filed Claims for SARS -CoV -2 Testing Package

Fill PhilHealth Waiver for Directly Filed Claims for SARS -CoV -2 Testing Package 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: Patient’s last name, first name, name extension, middle name, who belongs to sub-group, Name of PhilHealth accredited SARS-CoV-2 testing laboratory/HCP, Date/s of specimen collection (mm/dd/yyyy), Amount in words, Official Receipt No/s, Reason/s, Patient’s/member’s last name, first name, name extension, middle name, Designation of the authorized testing laboratory/HCP representative, Date signed, Signature over printed name of the patient/member/authorized representative.

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.

Fill PhilHealth Waiver for Directly Filed Claims for SARS -CoV -2 Testing Package now