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/
 

Download the PhilHealth Premium Payment Slip (PPPS)

For employers and PhilHealth members who are paying their premium contributions or remitting their payments through accredited collecting agents of PhilHealth, the PhilHealth Premium Payment Slip is now downloadable.

The PhilHealth Premium Payment Slip is currently being used by accredited collecting agents. The employer/member would need to fill-out the slip, present the slip and the payment to the agent. You should ensure that the slip is properly filled-out as the details you have reflected will be recorded in PhilHealth's database.

To avoid the long lines and ensure availability of the form, PhilHealth is now allowing access to the form in softcopy format. You may download the PhilHealth Premium Payment Slip here.

Employers: The PhilHealth Online Access Form (POAF)

The PhilHealth Online Access Form or POAF for short is used by employers to register or enroll in the Electronic Premium Reporting System (EPRS) or the PhilHealth-DepEd Text File Uploader System (DTFUS).

How can I get a copy of the POAF?

The POAF will be distributed to the employers during the conduct of training for the EPRS or DTFUS. Employers would need to fill-out the form with the corresponding information. Or you can click here to download the POAF. You will still be required to undergo training to be assigned an account to access the EPRS or DTFUS.

How to fill-up the POAF

Discussed from Left to Right.

• Name of Employer* = enter the complete registered name of the employer;
• PhilHealth Employer Number* = enter the number issued by PhilHealth upon registration of your company. If the registering office is a branch, the branch office should not use the PEN of the head office. Instead you may register first with PhilHealth to get your own PhilHealth Employer Number (PEN);
• Business Address* = complete address of the employer;
• Division Code / Station Code = this is used by the Department of Education to register corresponding offices. For other agencies just leave these blank. These are required for DepEd offices;
• Name and Position of Signatory* = the head of agency or the authorized representative of the employer;
• Signature* = of the signatory which grants approval to the user to access the EPRS or DTFUS in his/her behalf;
• Email address* = this is the email address of the signatory;
• Name and Position of User* = complete name of the authorized user;
• Email Address* = email address of user. This is required as the user account information will be sent in this email address;
• Account ID* = desired user name that will be used by the user;
• Mobile no. = Mobile number of the user. This may be used to contact the user relative to the user's account in the system.

* denotes required information and should not be left blank

For EPRS Use:

One POAF would correspond to one employer, hence in the case of a user handling or preparing reports of more than one employer, you would need to fill-out the POAF which corresponds to the number of employer accounts you have. Each employer should properly fill-out the Name and Position of Signatory and affix their signature signifying their consent to be represented by the user.

For previous users of the program which are no longer connected to the employer, the employer would need to fill-out a new POAF to register a new user. The previous user will be deactivated and a new password will be emailed to the new user.