PhilHealth Annex A.1: EMORPH Pre -Authorization Checklist: Upper and Lower Limb Prosthesis
Fill PhilHealth Annex A.1: EMORPH Pre -Authorization Checklist: Upper and Lower Limb Prosthesis 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, Middle Name, Suffix, 2. PhilHealth ID Number, Fulfilled selections criteria, If no, specify reason/s and encode, Age 18 years old, At least three months post-amputation, if acquired, Wheelchair independent, community-ambulator with or without, On physical examination: no fresh or non-healing wound,, Above knee/ knee disarticulation, Hip disarticulation, Van Ness Rotationplasty.
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