PhilHealth Annex "C": Amount after Patient Information Member Information Sub-groups of application
Fill PhilHealth Annex "C": Amount after Patient Information Member Information Sub-groups of application 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: Name of the PhilHealth accredited SARS-CoV-2 testing laboratory, PhilHealth Accreditation Number (PAN) , Address, PATIENT INFORMATION, Signature over printed name of the authorized signatory of the, Date signed, Signature over printed name of the Head of the.
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.