PH PHIC-ACCRE-AF-4 2009-2025 free printable template

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General Requirements 1. PhilHealth application form - properly accomplished 2. Warranties of Accreditation - duly notarized 3. Pasig City Health line 637-9999 loc. 1216 1217 1223 637-6265 www. philhealth. gov.ph PHIC-ACCRE-AF-4 APPLICATION FORM FOR ACCREDITATION PROFESSIONAL HEALTH CARE PROVIDER THE PRESIDENT CEO Philippine Health Insurance Corporation Pasig City Sir/Madam I of legal age hereby applies for accreditation under Sec. 52 of R.A. I undertake that all qualified NHIP beneficiaries are...given high quality of health care service due them without delay and I further undertake not to charge over and above the professional fees provided by the Program for indigent member beneficiaries of the NHIP administered by the PHIC if admitted in a ward type of accommodation reports/findings of pattern s or any other similar incident which may be indicative of any illegal irregular improper and/or unethical conduct or practice of my profession may be a ground at the discretion of the PHIC to...suspend shorten pre terminate and/or revoke my accreditation including the appurtenant benefits and opportunities incident thereto at any time during the term of my accreditation as may be determined by the PHIC to protect the interests of the NHIP compliance to all the basic precepts and tenets of my profession including all the laws guidelines policies and regulations regulating my profession including all the ethical standards required and governing the exercise of 15. I shall promote and...protect the NHI Program against abuse violation and/or over utilization of its Funds and I will not allow our institution to be a party to any act scheme plan or contract that may directly or indirectly be prejudicial to the Program 16. I shall not directly or indirectly engage in any form of unethical or improper practices as an accredited provider such as but not limited to solicitation of patients for purposes of compensability under the NHIP the purpose and/or the end consideration of which...tends unnecessary financial gain rather than promotion of the NHIP thereby ultimately undermining the greater interests and noble purpose of the NHIP 17. ANNEX B 1x1 Photo Republic of the Philippines PHILIPPINE HEALTH INSURANCE CORPORATION City State 709 Shaw Blvd. 7875 as amended by R*A 9241 and its Implementing Rules and Regulations thereto. For this purpose I hereby submit the following pertinent information and documentary requirements. ACCREDITATION NO. 1. CLASSIFICATION PHILHEALTH...IDENTIFICATION NO. 2. TYPE OF APPLICATION Dentist Initial General Practitioner GP GP w/ Training Midwife Training Medical Specialist Specialty 3. NAME OF PROFESSIONAL First Middle Re-accreditation Upgrading/downgrading w/ gap in accreditation Renewal Late filer 4. For Females Only Mother s Maiden Surname Last 5. SEX 6. CIVIL STATUS Male Female Single Widow Married 9. E-MAIL ADDRESS 8. BIRTHDATE mm/dd/yyyy 12. RESIDENTIAL ADDRESS No* / St* / Brgy. 7. TAX IDENTIFICATION NUMBER TIN Separated 10....FAX NO. 11. MOBILE NO. Municipality / City Province Zip Code 13. MAILING/ BILLING ADDRESS Contact No* 14.

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Comprehensive Guide to PHIC-ACCRE-AF-4: Application for Accreditation of Professional Health Care Providers

How to fill out a PHIC-ACCRE-AF-4 form

Filling out the PHIC-ACCRE-AF-4 form might seem daunting, but with a clear understanding of its components, it can be a straightforward task. Begin by gathering necessary personal and professional details, ensuring that every section is completed accurately. Use tools like pdfFiller for an efficient and error-free submission.

Understanding the PHIC-ACCRE-AF-4 form

The PHIC-ACCRE-AF-4 form is vital for healthcare providers seeking accreditation under the Philippine Health Insurance Corporation (PHIC). This accreditation legitimizes providers and allows them to participate in the national health insurance program.

Accreditation ensures that health care providers meet the standards set by PHIC, promoting quality care.
Recent amendments to the accreditation process reflect changes in healthcare delivery and regulations, making it critical for providers to stay informed.

What fields are included in the application?

The application requires detailed personal and professional information to ensure that the applicants meet necessary qualifications.

Applicants must provide their full name, date of birth, and contact details.
Categorizing applicants according to their professional qualifications is crucial for processing.
This information may influence eligibility and should be accurately presented.
Information on prior training and any previous accreditations is essential.

Filling out the PHIC-ACCRE-AF-4 form: step-by-step instructions

Accurate completion of the PHIC-ACCRE-AF-4 form is crucial for a successful application. Follow a structured approach to ensure clarity and precision in filling out the form.

Double-check all entries, especially names and numbers, to avoid any possible rejection of your application.
Compile all necessary documents like licenses and training certificates to accompany the application.
Common errors include incomplete fields or incorrect data, which can delay the accreditation process.

What are the compliance and legal notes to consider?

Understanding the legalities surrounding the PHIC accreditations is vital for all applicants. Compliance with regulations affects the application’s outcome significantly.

Familiarize yourself with the laws that govern health care accreditation in the Philippines.
Awareness of PHIC guidelines is necessary to ensure that the application meets required standards.
Failure to comply with the stated requirements can lead to disqualification from the accreditation process.

What does the document submission process involve?

After preparing the PHIC-ACCRE-AF-4 form and necessary documents, the next step is submitting them accurately. Understanding the online submission process is essential.

Use pdfFiller to submit forms online efficiently, taking advantage of features that streamline document handling.
Utilize online platforms to monitor the progress of your application continuously.
Organizing your documents digitally can help reduce stress and ensure quick access when needed.

How does pdfFiller enhance the experience?

Leveraging pdfFiller provides significant advantages in managing your forms and documents for accreditation applications.

With pdfFiller, you can easily edit and eSign your documents, making the process smoother.
Share and collaborate on documents with colleagues or mentors directly through the platform.
The ability to access documents from anywhere ensures that you can manage your application process efficiently.

Frequently Asked Questions about obtain the ph phic accre or your local phic office text fill in your personal information

What is the PHIC-ACCRE-AF-4 form?

The PHIC-ACCRE-AF-4 form is an application needed for health care providers in the Philippines seeking accreditation from the Philippine Health Insurance Corporation (PHIC). It is crucial for involvement in the national health insurance program.

How do I submit the PHIC-ACCRE-AF-4 form?

The form can be submitted online, often through a platform like pdfFiller, which helps streamline the process with document editing and signing functionalities.

What documents are needed for application?

You will need personal identification documents, professional licenses, and proof of residency training to complete your PHIC-ACCRE-AF-4 form application.

How can I check the status of my application?

Once submitted, you can track your application status through the online submission platform, which provides updates on its progress.

What are the implications of non-compliance?

Non-compliance, such as submitting incorrect information, can lead to rejection of your application and necessitate a resubmission, potentially delaying your accreditation.