PhilHealth Cf-4
Fill PhilHealth Cf-4 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: Series, Name of HCI, Accreditation Number, Address of HCI, Zip Code, Name of Patient, First Name, MiddleName, Chief Complaint, Admitting Diagnosis, Discharge Diagnosis, Ist Case Rate Code.
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.
Part of the form pack: A PhilHealth claim for a confinement (The downloads page lists Claim Form 4 as the clinical summary. This blank is CF4, Claim Form 4).
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.