PhilHealth Downloadable Forms

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Please find below Philhealth Downloadable forms.

MEMBERSHIP

Member Registration Form

CLAIMS

Guidelines: Philhealth Claim Form Guidelines
Member and Patient Information :Philhealth Claim Form 1
Provider Information: Philhealth Claim Form 2
Patient’s Clinical Record :Philhealth Claim Form 3

EMPLOYERS

ER 1: Employer Data Record
ER 2: Report of Employee Members
ER 3: Employer Data Amendment Form
RF 1: Employers Remittance Report
Instructions in Generating Textfile Report Using MS Excell

OTHER BENEFITS

Pre-Authorization Checklist and Request

Checklist for Mandatory and Other Request

 

 

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    Application Form for New Membership

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