PhilHealth Annex “ C 1 – Hearing Impairment ”
Fill PhilHealth Annex “ C 1 – Hearing Impairment ” 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, HEALTH CARE INSTITUTION (HCI), ADDRESS OF HCI, PATIENT (Last name, First name, Middle name, Suffix), PHILHEALTH ID NUMBER OF PATIENT, PHILHEALTH ID NUMBER OF MEMBER, Age Group at Pre-authorization, Otoacoustic emission test (OAE), Auditory brainstem response (ABR), Age Appropriate Behavioral Audiometry, Specify,, Diagnostic pure tone audiometry.
Free to try: 5 forms a day without an account; a free account gets 14 days of clean PDFs, then 25 a month. Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.