PhilHealth Annex A.2: Pre -authorization Checklist and Request for Closure of Ventricular Septal
Fill PhilHealth Annex A.2: Pre -authorization Checklist and Request for Closure of Ventricular Septal 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, 1. Last Name, First Name, Suffix, Middle Name, 2. PhilHealth ID Number, Same as patient (Answer the following only if the patient is a dependent), Fulfilled selections criteria, If no, specify reason/s and encode, Age up to 18 years and 364 days (Check if applicable), Ventricular Septal Defect (VSD) Closure, Date done (mm/dd/yy), No unstable congenital anomalies, Ventricular Septal Defect (VSD) Closure with Associated Special Conditions, Moderate aortic insufficiency not warranting replacement.
The form is the agency's own, from philhealth.gov.ph (checked 2026-10-14): the PDF you download is that form with your values printed in its boxes.
The free clean PDF is that pack’s shortest form. A later form in the same pack needs the Starter plan (₱499) or above. Preview, check, and verify stay free. Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.