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Claim Forms
Claim Form 1 - Member/Employer Certification
Claim Form 2 - Health Care Providers Certification
Claim Form 3 - Patient's Clinical Record
Claim Form 4, 4a and 4b - Maternity Care Package
Claim Form 5 - TB-DOTS Package
Enhanced Claim Forms
To be used in all admissions starting September 1, 2010 per
PhilHealth Circular No. 12,s-2010
Claim Form 1 - Member and Patient Information
Claim Form 2 - Provider Information
Claim Form 3 - Patient's Clinical Record
Guidelines on the Proper Accomplishment of
Revised PhilHealth Claim Forms 1, 2, and 3