PhilHealth Annex C.2: Checklist of Mandatory and Other Services - Premature Small Baby
Fill PhilHealth Annex C.2: Checklist of Mandatory and Other Services - Premature Small Baby 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: Registry No, 1. Last Name, First Name, Middle Name, Suffix, 2. PhilHealth ID Number, Born in another health facility, Non-institutional delivery (no attending HCP), 1. Essential intrapartum and newborn care (EINC), 2. Thermoregulation, 3. Newborn resuscitation, as needed, 4. Intensive care, as needed, 5. Surfactant therapy, as needed, 6. Ventilatory support, as needed, Mechanical ventilation.
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.