PhilHealth Self -Assessment/Survey Tool for Outpatient Benefit Package for Severe Acute Malnutrition
Fill PhilHealth Self -Assessment/Survey Tool for Outpatient Benefit Package for Severe Acute Malnutrition 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: Level, Date of Survey, Time started, Time ended, REMARKS, Clean consultation, examination, and treatment area, Display of pictorial steps of the WHO 1-2-3-4- 5 handwashing technique, Medical weighing scale* (Must be accurate to 100 grams), Mid-upper arm circumference (MUAC) tapes for six (6) to sixty (60) months old*, Pediatric Stethoscope, Non-mercury sphygmomanometer with infant and pediatric cuff, Non-mercury thermometer.
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.