PhilHealth Complications of
Fill PhilHealth Complications of 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: Registry No, 1. Last Name, First Name, Middle Name, Suffix, 2. PhilHealth ID Number, 1. Checklist of Eligibility Criteria (Annex A), 2. Checklist of Requirements for Reimbursement (Annex E.1 - Prevention of, 5. Checklist of Mandatory and Other Services (Annex C.1 - Prevention of, 8. Original or certified true copy (CTC) of the Statement of Account (SOA), DATE COMPLETED (mm/dd/yyyy), DATE FILED (mm/dd/yyyy), Certified correct by, Conforme by, PhilHealth Accreditation No.
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