PhilHealth Annex A: ZMORPH Pre-authorization Checklist and Request
Fill PhilHealth Annex A: ZMORPH Pre-authorization Checklist and Request 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, Last Name, First Name, Middle Name, Suffix, PhilHealth ID Number, Fulfilled selections criteria, If no, specify reason/s and encode, Place a check mark on the appropriate lower limb, 18 years, at least three months post-amputation, if acquired, with or without crutches, cane or walker, fresh or non-healing wound, neuroma or painful residual limb.
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.