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  • is NOT FOR SALE CSF - PhilHealth
    www philhealth gov ph email: actioncenter@philhealth gov ph IMPORTANT REMINDERS: PLEASE WRITE IN CAPITAL LETTERS AND CHECK THE APPROPRIATE BOXES All information required in this form are necessary Claim forms with incomplete information shall not be processed
  • Downloads - PhilHealth
    Claim Form 1: Member and Patient Information (Revised September 2018) Claim Form 2: Provider Information (Revised September 2018) Claim Form 3: Patient's Clinical Record
  • UPDATED CLAIM SIGNATURE FORM (CSF) AS A DOWNLOADABLE FORM - PhilHealth
    Pursuant to PhilHealth Circular 2016-0016 on the full implementation of the Electronic Claims, the Claim Signature Form (CSF) is one of the mandatory scanned image attachments in claims adjudication
  • UPDATED CLAIM SIGNATURE FORM (CSF), CLAIM FORMS 1 2 (CF 1 . . . - PhilHealth
    All accredited Health Care Institutions shall utilize the updated Claim Signature Form (CSF) as well as the Claim Forms 1 2 for all admissions starting October 1, 2018 The said forms
  • This form may be reproduced and is NOT FOR SALE CF-1 - PhilHealth
    www philhealth gov ph email: actioncenter@philhealth gov ph IMPORTANT REMINDERS: PLEASE WRITE IN CAPITAL LETTERS AND CHECK THE APPROPRIATE BOXES For local availment, this form together with other PhilHealth claim forms and other supporting documents should be filed within 60 days from date of discharge
  • guidelines on the proper accomplishment approved. pub (Read . . . - PhilHealth
    ACCOMPLISHMENT OF REVISED PHILHEALTH CLAIM FORMS 1, 2, 3 I General Guidelines applicable to all Claim Forms: 1 Claim Form 1 (CF1) and Claim Form 2 (CF2) shall be accomplished and submitted for ALL claim applications except for confinement abroad 2 All CF shall be accomplished using capital letters and by checking the appropriate boxes
  • This form may be reproduced and is NOT FOR SALE CF-2 - PhilHealth
    PhilHealth benefit is enough to cover HCI and PF Charges No purchase of drugs medicines, supplies, diagnostics, and co-pay for professional fees by the member patient Total Actual Charges*
  • PhilHealth Circular No. 21, series of 2014
    What is a Claim Signature Form (CSF)? The Claim Signature Form (CSF) contains portions from Claim Forms 1 and 2 that require signature from the hospital, member, patient, and employer (seeAnnex D ) whereapplicable, it should
  • PhilHealth Claim Form
    (Claim Form) revised November 2013 Day Year Vital Signs: Month BP : 2 Name of Patient PART I - PATIENT'S CLINICAL RECORD 1 PhilHealth Accreditation No (PAN) - Institutional Health Care Provider: Last Name, First Name, Middle Name (example: Dela Cruz, Juan Jr , Sipag) Time Admitted: 3
  • Important Reminders for the Implementation of PhilHealth Claim Forms 1 . . .
    Specific Reminder for Claim Form 3 (CF3) A properly and completely filled out Claim Form 3 shall be required for Maternity Care Package claims and for all cases managed in Primary Care Facilities





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