Forms
Downloadable PhilHealth forms for membership, claims, employers, Kasambahay, and other transactions. All files are in PDF format.
PDF 40
- PDFPhilHealth Member Registration Form (PMRF)
- PDFPMRF for Foreign Nationals
- PDFClaim Signature Form
- PDFClaim Form 1
- PDFClaim Form 2
- PDFPhilHealth Claim Form 3
- PDFPhilHealth Claim Form 4
- PDFClaim Form 1 Guidelines
- PDFClaim Form 2 Guidelines
- PDFClaim Form Reminders
- PDFClaim Form 4 Guidelines
- PDFAnnex A - eClaims System Connectivity Application Form (SCAF)
- PDFAnnex B - Non-Disclosure Agreement for eClaims
- PDFAnnex C - System Connectivity Agreement (SCA)
- PDFeClaims Cloud Storage Specifications
- PDFPCSS Application Form
- PDFAcknowledgement Receipt Form (ACKRF)
- PDFHealth Facility Electronic Report Form (HERF)
- PDFAnnex B - Template for Letter of Undertaking (MCP)
- PDFAnnex C - Antenatal Care Record
- PDFAnnex E - Post-Partum Care Record
- PDFPD Dialysis Registration Form
- PDFPD Dialysis Diagnosis Certification
- PDFHemodialysis Benefits Agreement Form
- PDFPPPS - Authority to Charge Account (ACA)
- PDFPPPS PhilHealth Form
- PDFEmployer Registration Form (ER1)
- PDFReport of Employee-Members (ER2)
- PDFReport of Employee Separation (ER3)
- PDFRemittance Form (RF1)
- PDFPEER Information Sheet
- PDFPEER Non-Disclosure Agreement
- PDFNDA for Authorized Collecting Agents
- PDFPhilHealth Online Access Form (POAF)
- PDFHousehold Employer Unified Registration Form
- PDFHousehold Employment Unified Report Form
- PDFKasambahay Unified Registration Form
- PDFHousehold PPS Form
- PDFAnnex B - Certificate of RRT as Add-on Service for Moderate to Severe Leptospirosis
- PDFAnnex C - Certificate of Invasive or Non-Invasive Ventilatory Support as Add-on Service for Moderate to Severe Leptospirosis
Accreditation Documents
Accreditation-related documents and requirements for health facilities and professionals. Expand the section on the live site to view and download files.
Z Benefits
Includes documents for Expanded Z Benefits such as ZMORPH for Lower Limb Orthosis, ZMORPH for Spinal Orthosis, Prevention of Complications of Preterm Delivery, and Premature or Small Baby. Expand the section on the live site to view and download files.
Specialized Outpatient Benefit Documents
Documents related to Specialized Outpatient Benefits. Expand the section on the live site to view and download files.
YAKAP
Documents related to YAKAP (Yaman ng Kalusugan Program). Expand the section on the live site to view and download files.
IEC Materials
Information, education, and communication materials for members and the public. Expand the section on the live site to view and download files.