PhilHealth Annex “A – Mobility Impairment ”
Fill PhilHealth Annex “A – Mobility 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, MEMBER (if patient is a dependent) (Last name, First name, Middle name, Suffix), PHILHEALTH ID NUMBER OF MEMBER, Fulfilled selections criteria, If no, specify reason/s and encode, The child’s chronological age is 0 to 17 years and 364 days old, If acquired amputation, the limb is at least 3 months post-surgery, Disorders resulting to mobility impairment.
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.