SSS Ecmed Evaluation Sheet
Fill SSS Ecmed Evaluation Sheet 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: CONTROL NUMBER, CLAIM NUMBER, NAME OF MEMBER, CLAIM TYPE, CONFINEMENT INDICATOR, DATE ADMITTED (MMDDYYYY), DATE DISCHARGED (MMDDYYYY), Wound, Multiple Injuries, Malignancy, Hearing Loss, Fracture/Sprain.
The form is the agency's own, from sss.gov.ph (checked 2026-10-14): the PDF you download is that form with your values printed in its boxes.
Part of the form pack: SSS sickness benefit papers (The download page lists an ECMED Evaluation Sheet. This blank is MED-01192, and its own parts are filled by the senior clerk and the medical specialist).
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.