PhilHealth Annex E3.1: Rectal Cancer Pre -Operative Clinical Stage I with Post -Operative
Fill PhilHealth Annex E3.1: Rectal Cancer Pre -Operative Clinical Stage I with Post -Operative 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, 2. Photocopy of approved Pre-Authorization Checklist & Request, 7. Photocopy of the Multidisciplinary-interdisciplinary team (MDT) Plan, 8. Original or certified true copy (CTC) of the Statement of Account (SOA), 9. Photocopy of accomplished surgical operative record, 10. Photocopy of accomplished anesthesia report, 11. Photocopy of the histopathology result after definitive surgery, DATE COMPLETED (mm/dd/yyyy), DATE FILED (mm/dd/yyyy), Certified correct by.
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