PhilHealth Forms

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					PhilHealth Forms



View/Print PhilHealth Forms
Claim Form 1            Member's Data Record
Claim Form 2            Hospital Data Record
Claim Form 3            Patient's Clinical Record
ME-5                    Contributions Payment Return (Employed Sector)
MI-5
                        Contributions Payment Return (Individually Paying
                        Members)
M1a                     Member Data Record (For Employed Sector)
M1b                     Member Data Record (For Individually Paying)
ER1                     Employer Data Record
ER2                     Report of Employee-Members
Er1P                    Employer Data Record (For Private Sector)
RF-1                    Employer Quarterly Remittance Report




Please read instructions before printing any Form.




Instructions for Printing PhilHealth Forms (Claim Form 1, Claim Form 2 and
Claim Form 3):

1. Click "File" from the menu bar.




2. Click "Page Setup".
3. Set the following items from the Paper Size field: "Legal"

4. Click the radiobutton before "Portrait" from the "Orientation" field.
5. Set the following items from the "Margins(Inches)" field: Left:0.25", Right:0.25",
Top:0.25", Bottom:0.25"




6. Delete the items from the "Headers and Footers" field.
7. Click "OK" and you are now ready to print the forms.




Instructions for Printing PhilHealth Forms (ME-5, MI-5, M1a, M1b, ER1):

1. Do steps 1,2,4,5 & 6 from the previous instructions.
2. Set the following items from the "Paper Size" field: "Letter".
3. Click OK and you are now ready to print the forms.




Instructions for Printing PhilHealth Forms (ER2, Er1P, RF-1):

1. Do steps 1, 2, 5 & 6 from the previous instructions.
2. Set the following items from the "Paper Size" field: "Letter".
3. Click the radiobutton before "Landscape" from the "Orientation" field.




4. Click "OK" and you are now ready to print the forms.