PhilHealth Annex A: Agreement Form
Fill PhilHealth Annex A: Agreement Form 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: Date (Month/Day/Year), I have been fully informed by Dr./Mr./Ms. ____________________________ of the, Iron Sucrose 20 mg/mL, 5 mL ampule, 1. Complete blood count, 2. Serum creatinine, 3. BUN, 4. Hepatitis profile, 5. Alkaline phosphatase, 6. Potassium, 7. Phosphorus, 8. Calcium, 9. Sodium.
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