A PhilHealth claim for a confinement: your forms
A member or a hospital is filing a PhilHealth claim and needs the claim forms the downloads page lists apart from the member registration form.
Forms in this pack: Claim Signature Form; Claim Form 1 (member and patient); Claim Form 2 (provider); Claim Form 3 (clinical record); Claim Form 4 (clinical summary).
Claim Signature Form: PhilHealth's downloads page lists the Claim Signature Form, revised September 2018, as its own row. This blank is headed CSF, Claim Signature Form, revised September 2018.
Claim Form 1 (member and patient): The downloads page lists Claim Form 1, member and patient information, revised September 2018. This blank is CF-1, revised September 2018.
Claim Form 2 (provider): The downloads page lists Claim Form 2, provider information, revised September 2018. This blank is CF-2, revised September 2018.
Claim Form 3 (clinical record): The downloads page lists Claim Form 3 as the patient's clinical record. This blank is CF3, Part I Patient's Clinical Record.
Claim Form 4 (clinical summary): The downloads page lists Claim Form 4 as the clinical summary. This blank is CF4, Claim Form 4.
The downloads page lists the Claim Signature Form, Claim Form 1, Claim Form 2, Claim Form 3, and Claim Form 4 as separate rows from the member registration form, and it links guidelines for Claim Form 1, Claim Form 2, and Claim Form 4.
Not for: Joining PhilHealth. That is the PMRF, already in the first-job and OFW packs.
Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.