Loading
             
                Get Philhealth Referral Form
How it works
- 
                    Open form follow the instructions
- 
                    Easily sign the form with your finger
- 
                    Send filled & signed form or save
How to fill out the Philhealth Referral Form online
Navigating the Philhealth Referral Form can seem daunting, but this guide will help you complete it with ease. We will provide clear instructions for each section, ensuring that you have all the necessary information for a smooth process.
Follow the steps to complete the Philhealth Referral Form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill out the 'Referring Health Care Institution' section. Enter the date of referral and time of referral in the designated fields. Next, input the name of the health care institution (HCI) along with its PhilHealth accreditation number and address.
- Provide details about the attending or referring physician by entering their name and ensuring to include their signature in the space provided.
- In the 'Patient Information' section, fill in the patient's name, date of birth, and age. Clearly state the diagnosis or diagnoses along with the associated ICD 10 codes.
- Explain the reasons for referral or transfer in the specified section, making sure to be as clear and concise as possible.
- Complete the 'Referral Health Care Institution' section by entering the date and time of receipt by the receiving institution.
- Provide the name of the health care institution (HCI) that will receive the patient, along with its PhilHealth accreditation number and address.
- Indicate the name of the receiving physician and ensure their signature is documented in the form.
- Finally, fill in the name of the nurse on duty and obtain their signature.
- After completing all sections, review the form for accuracy. Users can then save their changes, download a copy, print the completed form, or share it as needed.
Complete your Philhealth documents online today for a hassle-free submission process.
To fill up a referral form, begin by entering the patient's accurate personal information and any relevant medical history. Next, indicate the reason for the referral and the specific services required. The Philhealth Referral Form typically has clear sections, so follow the instructions provided to ensure completeness. Before submitting, review all entries for accuracy to avoid any complications.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
        - 
                    In businnes since 199725+ years providing professional legal documents.
- 
                    Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
- 
                    Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.