Sunday, April 22, 2012

Glossary of PhilHealth forms and download links

Membership

PMRF: PhilHealth Member Registration Form - Download

Claims

Claim Form 1: Member and Patient Information - Download
Claim Form 2: Provider Information - Download
Claim Form 3: Patient's Clinical Record - Download

Employers

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

Accreditation

Institutional

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

Professional

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

Collecting Agents

CAAF: Collecting Agents Accreditation Form - Download

Payment

PPPS: PhilHealth Premium Payment Slip - Download

eClaims

HCPAP: Health Care Provider Account Profile application form - Download

Reference: http://www.philhealth.gov.ph/downloads/