PhilHealth Annex “ G – RF/RHD ”
Fill PhilHealth Annex “ G – RF/RHD ” online and download the official form as a PDF, ready to print. Every input is mapped to its printed box, so IDs, dates and amounts land digit by digit in the right cells, and a value the form cannot hold is refused with the reason instead of being printed wrong.
What you will need: Case No, HEALTH CARE INSTITUTION (HCI), ADDRESS OF HCI, 1. Last Name, First Name, Middle Name, Suffix, 2. PhilHealth ID Number, (Name of Patient), (Date of Birth), (Address), was diagnosed with rheumatic fever/rheumatic heart disease on, (antibiotic prophylaxis), (Name of Physician), Conforme by.
The form is the agency's own, from philhealth.gov.ph (checked 2026-10-14): the PDF you download is that form with your values printed in its boxes.
The free clean PDF is that pack’s shortest form. A later form in the same pack needs the Starter plan (₱499) or above. Preview, check, and verify stay free. Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.