PhilHealth Annex "E1.1 – Cervical CA”
Fill PhilHealth Annex "E1.1 – Cervical CA” 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, HEALTHCARE PROVIDER (HCP), ADDRESS OF HCP, 1. Last Name, First Name, Suffix Middle Name, 2. PhilHealth ID Number, Same as patient, 1. Last Name, First Name, Suffix, Middle Name, 2. Photocopy of approved Pre –Authorization Checklist & Request, 7. Photocopy of accomplished operative surgical report, 8. Photocopy of accomplished anesthetic report, 10. Photocopy of histopathology result (definitive surgery), Certified correct by.
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