PhilHealth Self -assessment / Survey Tool for the Outpatient Benefits Package for General Mental
Fill PhilHealth Self -assessment / Survey Tool for the Outpatient Benefits Package for General Mental 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, Mandatory Ancillary Services, Medications, Human Resources, Laboratory, Radiology Diagnostic, Psychotherapy, Available Forms/ Recordings, Surveyor's Name.
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.