PhilHealth Annex I.2B: Checklist of Essential Health Services Using APD PD Bags - Pediatric
Fill PhilHealth Annex I.2B: Checklist of Essential Health Services Using APD PD Bags - Pediatric 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, DATE OF CONSULTATION (mm/dd/yyyy), Last Name, First Name, Suffix, Middle Name, PhilHealth ID Number, Same as patient, Name of the Attending Pediatric Nephrologist, 2.5 % or 2.3 %, 4.25%, B. Number of exchanges covered by PhilHealth per day, C. Calcium content, APD Cassette, APD Drain bag.
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.