Download Government Forms
Philippine Health Insurance Corp. (PhilHealth)
To download, Right-Click then Save Target As. You will also need to download Adobe Reader to view and/or print the PDF document.
Claims Forms:
Claim Form 1 - Member's Data Record
Claim Form 2 - Hospital Data Record
Claim Form 3 - Patient's Clinical Record
Claim Form 4, 4A & 4B - Maternity Care Package
Claim Form 5 - TB-DOTS PackageMembership Forms
Membership Forms:
M1a Form - Member Data Record (For Employed Sector)
M1b Form - Member Data Record (For Individually Paying)
M1c Form - Member Data Record (For Non-Paying Members)
M2 Form - Membership Amendment FormContribution
Forms contribution Forms:
ER1 Form - Employer Data Record
ER2 Form - Report of Employee-Members
ER3 Form - Employer Data Amendment Form
RF-1 Form - Employer Quarterly Remittance Report
Accreditation Forms:
A. Institutional Health Care Providers
Tertiary Hospitals w/ training
Free Standing Dialysis Clinics
Rural Health Units/ Health Centers
Maternity Care Clinics/ Lying-in Clinics
Self Assessment Checklist for Applying DOTS Center
Monthly Mandatory Hospital Report
B. Professional Health Care Providers
