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Kindly accomplish the following:

1.    Duly accomplished original Claim Signature Form (CSF) Revised September 2018.
2.    Duly accomplished Claim Form 2 (CF2).
3.    Generate Philhealth Benefit Eligibility Form (PBEF).
(Proceeds to PHILHEALTH SECTION upper ground floor, window 5, 6, and 7).

•    If the PBEF indicated YES, submit properly accomplished CSF and duly sign PBEF by member/representative.
•    If the PBEF indicated NO, accomplished the needed requirements and submit properly accomplished CSF and duly sign PBEF by member/representative.

  • FOR CURRENTLY EMPLOYED

*Claim Signature Form (CSF) signed by employer
*Certificate of Contribution
*Member Data Record (MDR)
*Proof of dependency if patient is dependent

  • FOR INDIVIDUALLY PAYING/ SELF EMPLOYED/ VOLUNTARY

*Proof of payment
*Member Data Record (MDR)
*Proof of dependency if the patient is dependent

  • FOR AFP, PNP, RETIRED SSS AND GSIS EMPLOYEE

*Member Data Record (MDR) or Non-Paying Member ID
*Proof of dependency if the patient is dependent

  • FOR OFW OR OWWA MEMBER

*Member Data Record (MDR) issued by Philhealth with an updated coverage period
*Proof of dependency if the patient is dependent

  • FOR INDIGENT MEMBER

*Member Data Record (MDR) issued by Philhealth with an updated coverage period
*Proof of dependency if the patient is dependent

4. Properly accomplished Philhealth Member Registration Form (PMRF) with a valid proof of Identity and supporting documents to establish the relationship between member and dependent if needed.


NOTE: 

A.    Upon discharge, the nurse station shall forward CSF (if applicable), CF2 and Operative Record to Billing Section for processing of Philhealth Benefit.

B.    For Out-Patient, proceed to PHILHEALTH SECTION to accomplish forms, submit supporting documents and generate PBEF prior to the procedure/operation.

 

ALL REQUIRMENTS MUST BE SUBMITTED PRIOR TO DISCHARGE
 

Far Eastern University – Dr. Nicanor Reyes Medical Foundation respects your privacy and will keep secure and confidential all personal and sensitive information that you may provide to FEUNRMF Medical Center and/or those that FEUNRMF Institute of Medicine may collect from you ("Personal Data").

Please read carefully the FEUNRMF Privacy Statement to understand how we treat Personal Data.

Click here to read the Privacy Statement in full.