PhilHealth Annex A.3: EMORPH Pre -Authorization Checklist: Spinal Orthosis
Fill PhilHealth Annex A.3: EMORPH Pre -Authorization Checklist: Spinal 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, Upon diagnosis and/or post-operative clearance, No sensory deficit over body segment of application, Upper and lower limb manual muscle strength of, Thoracolumbar (T12-L2) spinal fractures involving posterior elements, Primary or metastatic lesions to the thoracolumbosacral spine, Lumbosacral fractures (L1-L3), Primary or metastatic lesions to the lumbosacral spine.
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