PhilHealth Certificate of classification of at -risk individuals and actual charges

Fill PhilHealth Certificate of classification of at -risk individuals and actual charges 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), No charge to patient, If with actual charges, indicate the following, Total actual charges, Amount after application of discounts/deductions (senior, PhilHealth benefit package amount, Official receipt no./s, Designation of the authorized testing laboratory/HCP representative, Date signed.

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