PhilHealth Annex F: Self -Assessment/Survey Tool
Fill PhilHealth Annex F: Self -Assessment/Survey Tool 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: Date of Survey (mm/dd/yyyy), Time started, Time ended, PhilHealth Survey Team, Remarks/Action Plan, 2.1 The hospital has at least a Level II (PSNbM NEOHAB 2020) PHIC, 2.1 The hospital has at least a Level II (PSNbM NEOHAB 2020) REMARKS, 2.1.1 Comprehensive High-risk and Intensive Care PHIC, 2.1.1 Comprehensive High-risk and Intensive Care REMARKS, 2.1.2 Special / continuing care / step down services or unit PHIC, 2.1.2 Special / continuing care / step down services or unit REMARKS, 2.1.3 Isolation area PHIC.
The form is the agency's own 2024 edition, 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.