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This form may be reproduced and is NOT FOR SALECF1(Claim Form 1)
revised November 2013
Series #IMPORTANT REMINDERS:
PLEASE WRITE IN CAPITAL LETTERS AND CHECK THE APPROPRIATE BOXES.
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How to fill out philhealth claim form 1
How to fill out philhealth claim form 1
01
Step 1: Obtain a copy of PhilHealth Claim Form 1. You can download it from the official PhilHealth website or obtain it from any PhilHealth office.
02
Step 2: Fill out your personal information. Provide your complete name, address, contact number, and PhilHealth identification number.
03
Step 3: Indicate the details of the patient. Fill in the patient's name, address, birthdate, and other relevant information.
04
Step 4: Provide the details of the attending physician. Include the doctor's complete name, address, and license number.
05
Step 5: Specify the details of the hospital or healthcare facility where the patient received treatment. Include the name, address, and PhilHealth accreditation number.
06
Step 6: Describe the diagnosis or nature of the illness or injury that required medical treatment.
07
Step 7: Fill in the dates of confinement or outpatient service, as well as the total number of days.
08
Step 8: Indicate the services rendered by checking the appropriate boxes or providing the necessary information for each service.
09
Step 9: Compute the amount claimed for each service and indicate the corresponding charges.
10
Step 10: Sign the form and provide the date of signing. Make sure to review the form for accuracy before submission.
Who needs philhealth claim form 1?
01
Individuals who have received medical treatment and are eligible for PhilHealth benefits need PhilHealth Claim Form 1.
02
This form is required for those who intend to claim reimbursement for medical expenses covered by PhilHealth.
03
Patients who were admitted to hospitals, underwent surgical procedures, or received outpatient services can use this form to file a claim.
04
Both PhilHealth members and their dependents can make use of PhilHealth Claim Form 1 when seeking reimbursement.
05
It is essential to ensure that all the necessary information is accurately provided on the form to avoid delays in processing the claim.
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What is philhealth claim form 1?
PhilHealth Claim Form 1 is a document used to request reimbursement from PhilHealth for medical expenses.
Who is required to file philhealth claim form 1?
PhilHealth members or their authorized representatives are required to file PhilHealth Claim Form 1.
How to fill out philhealth claim form 1?
To fill out PhilHealth Claim Form 1, you need to provide personal information, details of the medical expenses, and supporting documents.
What is the purpose of philhealth claim form 1?
The purpose of PhilHealth Claim Form 1 is to request reimbursement from PhilHealth for medical expenses incurred.
What information must be reported on philhealth claim form 1?
The information that must be reported on PhilHealth Claim Form 1 includes personal details, medical expenses incurred, and supporting documents.
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