PhilHealth Annex “ C 1 – ALL ”: (Answer the following only if the patient is a dependent)
Fill PhilHealth Annex “ C 1 – ALL ”: (Answer the following only if the patient is a dependent) 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, HEALTH CARE PROVIDER (HCP), ADDRESS OF HCP, 1. Last Name, First Name, Middle Name, Suffix, 2. PhilHealth ID Number, Same as patient, DATE OF END OF INDUCTION PHASE (mm/dd/yyyy), Bone marrow aspirate examination (morphologic, CSF analysis with WBC differential count, CBC (with platelet count), Alanine aminotransferase (ALT), Bilirubin.
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.