PhilHealth Annex E4.2: Rectal Cancer Pre-treatment Clinical Stage II to III: Post-surgery
Fill PhilHealth Annex E4.2: Rectal Cancer Pre-treatment Clinical Stage II to III: Post-surgery 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, 2. Photocopy of approved Pre-Authorization Checklist & Request, 7. Photocopy of the Multidisciplinary-interdisciplinary Team (MDT) Plan, 8. Original or certified true copy (CTC) of the Statement of Account (SOA), 9. Photocopy of accomplished surgical operative record, 10. Photocopy of accomplished anesthesia report, 11. Histopathology result after definitive surgery, DATE COMPLETED (mm/dd/yyyy), DATE FILED (mm/dd/yyyy), Certified correct by.
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.