PhilHealth Annex “ J – Visual Disabilities ”
Fill PhilHealth Annex “ J – 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, PATIENT (Last name, First name, Middle name, Suffix), BIRTHDAY (mm/dd/yyyy), ADDRESS, CONTACT NUMBER, This certifies that patient, Training on the use of the device, Training on activities of daily living, Visual skills training, Environmental adaptation, Others, specify, Remarks (if any).
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.