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ICD 10 Code
RVS Code
Description
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Item Code
Description
Case Rate Code
Item Description
Effectivity
Primary HCI Fee
Primary Prof. Fee
Primary Case Rate
Secondary HCI Fee
Secondary Prof. Fee
Secondary Case Rate

Lastname
Firstname
Middlename
Suffix
Birthdate
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Member PIN

Philhealth Employer No.
PhilHealth Employer Name
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PEN	Employer Name	Address

Lastname
Firstname
Middlename
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Birthdate
TIN
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Doctor PAN:

Accreditation Code
Admission Date
Discharge Date
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