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Philippine Health Insurance Corp.
(PhilHealth)

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:

Institutional Health Care Providers
• Primary Hospitals >Click here<
• Secondary Hospitals >Click here<
• Tertiary Hospitals >Click here<
• Tertiary Hospitals w/ training >Click here<
• Ambulatory Surgical Clinics >Click here<
• Free Standing Dialysis Clinics >Click here<
• Rural Health Units/ Health Centers >Click here<
• Maternity Care Clinics/ Lying-in Clinics >Click here<
• DOTS Clinics >Click here<
• Self Assessment Checklist for Applying DOTS Center
>Click here<
• Monthly Mandatory Hospital Report >Click here<

B. Professional Health Care Providers
• Physicians >Click here<
• Dentists >Click here<
• Midwives >Click here<

Other Forms:

•	Social Security System (SSS)
•	Air Transportation Office (ATO)
•	Department of Social Welfare and Development (DSWD)
•	Department of Foreign Affairs (DFA)
•	Philippine Health Insurance Corp. (PhlHealth)
•	Department of Labor and Employment (DOLE)
•	Bureau of Immigration (BI)

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