PhilHealth Annex “ A – Visual Disabilities ”
Fill PhilHealth Annex “ A – Visual Disabilities ” 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, Fulfilled selections criteria, If no, specify reason/s and encode, Status, Child's best-corrected visual acuity in the better eye (please tick one), The child has an enucleated eye, Other clinical indications determined by ophthalmologists.
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.