PhilHealth Annex A.2: EMORPH Pre -Authorization Checklist: Lower Limb Orthosis
Fill PhilHealth Annex A.2: EMORPH Pre -Authorization Checklist: Lower Limb Orthosis 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, At least 3 months post-onset, Upper limbs, Unaffected limbs, Ambulatory with assistive device, No fresh or non-healing wound, Weakness or absence of dorsiflexors and/or plantarflexors, +/- grade 1-, Equinovarus +/- foot rotation and +/- grade 1-2 spasticity with full.
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