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 REQUIREMENTS MUST BE SUBMITTED PRIOR TO DISCHARGE