PhilHealth Annex E3.3: Rectal Cancer Pre -Operative Clinical Stage I with Post -operative
Fill PhilHealth Annex E3.3: 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 chemotherapy treatment summary form, 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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