Philhealth Forms

Membership

• PMRF: PhilHealth Member Registration Form

Claims

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

• PhilHealth Claim Form Guidelines »»

Employers

• ER1: Employer Data Record
• ER2: Report of Employee-Members
• ER3: Employer Data Amendment Form
• RF1: Employer’s Remittance Report

Accreditation

Institutional

• IAF: Institutional Accreditation Form
• MMHR: Monthly Mandatory Hospital Report
• SOI: Statement of Intent for Hospital, ASC and FSDC
• SOI: Statement of Intent for OPB, MCP and DOTS Providers

Professional

• PAF: Professionals Accreditation Form with Warranties for Accreditation and Checklist of Requirements

Collecting Agents

• CAAF: Collecting Agents Accreditation Form

Primary Care Benefit 1

• Manual of Procedures for Providers

Payment

• PPPS: PhilHealth Premium Payment Slip

eClaims

• HCPAP: Health Care Provider Account Profile application form