Local Government Unit of Kabacan
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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

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