PhilHealth Annex "E1.2 – Cervical CA”
Fill PhilHealth Annex "E1.2 – 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, 2. Photocopy of approved Pre –Authorization Checklist & Request, 7. Original copy of medical certificate of Out-Patient Follow up Consultation, Certified correct by, PhilHealth Accreditation No, Date signed (mm/dd/yyyy), Conforme by.
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