PhilHealth Annex A.4: Health Facilities Standards
Fill PhilHealth Annex A.4: Health Facilities Standards 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: Date of Survey, Time started, Time ended, 5.18 Urine drug test (Specify), Surveyor's Name, Names of Management Team, Remarks, Clean consultation and examination area, An enclosed room that respects the privacy of the patients, Alcohol hand rub, Adult Stethoscope, Pediatric Stethoscope.
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.