PhilHealth Annex “ H ” Transmittal Form of Claims for the Outpatient Benefits for RF/RHD

Fill PhilHealth Annex “ H ” Transmittal Form of Claims for the Outpatient Benefits for 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: NAME OF CONTRACTED HEALTH CARE INSTITUTION (HCI), ADDRESS OF HCI, Case Number, Printed Name and Signature, Designation, Date signed (mm/dd/yyyy).

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.

Fill PhilHealth Annex “ H ” Transmittal Form of Claims for the Outpatient Benefits for RF/RHD now

• The blank form from philhealth.gov.ph