Claims

Id Test type Summary
1 Manual Claims tab
1 Manual
1 Manual
2 Manual Claims tab when not has any claim
2 Manual
2 Manual
3 Manual Claims tab when has any claim
3 Manual
3 Manual
4 Manual Claims tab
4 Manual
4 Manual
5 Manual Button More + at Claims tab
5 Manual
5 Manual
6 Manual For Filing Claims tab
6 Manual
6 Manual
7 Manual Refiled Claims tab

7 Manual
7 Manual
8 Manual Button Create New Claim
8 Manual
8 Manual
9 Manual 1. Eligibity tab
9 Manual
9 Manual
9 Manual
10 Manual Button Back to Check Eligibility
10 Manual
10 Manual
10 Manual
10 Manual
11 Manual 2. CF1 tab
11 Manual
11 Manual
11 Manual
12 Manual General Details section of 2. CF1 tab
12 Manual
12 Manual
12 Manual
12 Manual
Member Information section:

13 Manual
section of 2. CF1 tab
13 Manual
13 Manual
13 Manual
13 Manual
Member's Address Information

14 Manual
section: section of 2. CF1 tab
14 Manual
14 Manual
14 Manual
14 Manual
Patient Information section: section

15 Manual
of 2. CF1 tab
15 Manual
15 Manual
15 Manual
15 Manual
Employer Information section:

16 Manual
16 Manual
16 Manual
16 Manual
16 Manual
17 Manual
17 Manual
17 Manual
Confinement Information section of

18 Manual
3. CF2 tab
18 Manual
18 Manual
18 Manual
18 Manual
19 Manual Diagnosis section of 3. CF2 tab

19 Manual
19 Manual
19 Manual
19 Manual
Button + Add RVS at Diagnosis

20 Manual
20 Manual
20 Manual
20 Manual
20 Manual
Button + Add discharge Diagnosis at

20 Manual
Diagnosis section of 3. CF2 tab
20 Manual
20 Manual
20 Manual
20 Manual
21 Manual Case Rates section of 3. CF2 tab
21 Manual
21 Manual
21 Manual
21 Manual
Button + Add at Case Rates section
21 Manual
of 3. CF2 tab
21 Manual
21 Manual
21 Manual
21 Manual
Special Considerations section of 3.

22 Manual
CF2 tab
22 Manual
22 Manual
22 Manual
22 Manual
Button + Add at Special

23 Manual
Considerations section of 3. CF2 tab
23 Manual
23 Manual
23 Manual
23 Manual
For MCP (Enumerate four dates

24 Manual (mm-dd-yyyy) of pre-natal check-
ups) section of 3. CF2 tab
24 Manual
24 Manual
24 Manual
24 Manual
For TB DOTS Package section of 3.

25 Manual
CF2 tab
25 Manual
25 Manual
25 Manual
25 Manual
For Animal Bite Package (Write the

dates (mm-dd-yyyy) when the
26 Manual
following doses of vaccine were
given) section of 3. CF2 tab
26 Manual
26 Manual
26 Manual
26 Manual
Newborn Care Details section of 3.

27 Manual
CF2 tab
27 Manual
27 Manual
27 Manual
27 Manual
HIV/AIDS Treatment Details section

28 Manual
of 3. CF2 tab
28 Manual
28 Manual
28 Manual
28 Manual
Cataract Treatment Details section

29 Manual
of 3. CF2 tab
29 Manual
29 Manual
29 Manual
29 Manual
Professional Fees / Charges section

30 Manual
of 3. CF2 tab
30 Manual
30 Manual
30 Manual
30 Manual
Certification of Consumption of
31 Manual
Benefits section of 3. CF2 tab
31 Manual
31 Manual
31 Manual
31 Manual
Total Health Care Institution Fee
32 Manual
section
32 Manual
32 Manual
32 Manual
32 Manual
32 Manual
33 Manual Total Professional Fee section
33 Manual
33 Manual
33 Manual
33 Manual
33 Manual
Purchases/Expenses NOT included
34 Manual
in the HCI charges section
34 Manual
34 Manual
34 Manual
34 Manual
34 Manual
35 Manual Access Patient Record section
35 Manual
35 Manual
35 Manual
35 Manual
"Patient" selection at Signed By of

36 Manual
Access Patient Record section
36 Manual
36 Manual
36 Manual
36 Manual
36 Manual
"Representative" selection at Signed

37 Manual
By of Access Patient Record section
37 Manual
37 Manual
37 Manual
37 Manual
37 Manual
"Thumbmark" selection at Signed

38 Manual
By of Access Patient Record section
38 Manual
38 Manual
38 Manual
38 Manual
38 Manual
39 Manual
39 Manual
39 Manual
Availed Maternity Care Package

40 Manual
when select No
40 Manual
40 Manual
40 Manual
40 Manual
Availed Maternity Care Package

41 Manual
when select Yes
41 Manual
41 Manual
41 Manual
41 Manual
42 Manual Consultation Information section
42 Manual
42 Manual
42 Manual
42 Manual
42 Manual
43 Manual Complaints Information section
43 Manual
43 Manual
43 Manual
43 Manual
43 Manual
44 Manual Maternity Details section
44 Manual
44 Manual
44 Manual
44 Manual
44 Manual
45 Manual Obstetric History section
45 Manual
45 Manual
45 Manual
45 Manual
45 Manual
46 Manual Medical Surgery section
46 Manual
46 Manual
46 Manual
46 Manual
46 Manual
47 Manual Delivery Information section
47 Manual
47 Manual
47 Manual
47 Manual
47 Manual
48 Manual Post Partrum Information section
48 Manual
48 Manual
48 Manual
48 Manual
48 Manual
49 Manual Post Partrum Information section
49 Manual
49 Manual
49 Manual
49 Manual
49 Manual
Button "Click Here To Add Drug
50 Manual
Medicine" of Drug Medicine section
50 Manual
50 Manual
50 Manual
50 Manual
50 Manual
50 Manual
Button "Click Here To Add XLSOS" of

50 Manual
XLSOS section
50 Manual
50 Manual
50 Manual
50 Manual
50 Manual
50 Manual
51 Manual
51 Manual
51 Manual
"Yes" selection at Should include
52 Manual
CF4
52 Manual
52 Manual
52 Manual
52 Manual
PROFILING - Health Screening &

53 Manual
Assessment section
53 Manual
53 Manual
53 Manual
53 Manual
53 Manual
54 Manual Chief Complaint section
54 Manual
54 Manual
54 Manual
54 Manual
54 Manual
55 Manual Reason for Admission section
55 Manual
55 Manual
55 Manual
55 Manual
55 Manual
OB/GYN History (For female Patient

56 Manual
Only) section
56 Manual
56 Manual
56 Manual
56 Manual
56 Manual
Pertinent Signs and Symptoms on

57 Manual
Admission section
57 Manual
57 Manual
57 Manual
57 Manual
57 Manual
Physical Examination on Admission

58 Manual (Pertinent Findings per System)
section
58 Manual
58 Manual
58 Manual
58 Manual
58 Manual
PEPERT (Physical Examination

Findings for BP Measurements,
59 Manual
Heart and Respiratory Rate, Body
Measurements and Vision) section
59 Manual
59 Manual
59 Manual
59 Manual
59 Manual
PEMISC (Physical Examination

Findings for Skin, Heent, Chest,
60 Manual
Heart, Abdomen, Neuro, Rectal and
Genitourinary) section
60 Manual
60 Manual
60 Manual
60 Manual
60 Manual
Value of dropdown list Heent

61 Manual
Description and logic
61 Manual
61 Manual
61 Manual
61 Manual
61 Manual
61 Manual
Value of dropdown list Chest/Lungs

62 Manual
62 Manual
62 Manual
62 Manual
62 Manual
62 Manual
62 Manual
Value of dropdown list CVS/Heart

63 Manual
63 Manual
63 Manual
63 Manual
63 Manual
63 Manual
63 Manual
Value of dropdown list Abdomen

64 Manual
64 Manual
64 Manual
64 Manual
64 Manual
64 Manual
64 Manual
Value of dropdown list Abdomen

65 Manual
65 Manual
65 Manual
65 Manual
65 Manual
65 Manual
65 Manual
Value of dropdown list Skin /

66 Manual
Extremities Description and logic
66 Manual
66 Manual
66 Manual
66 Manual
66 Manual
66 Manual
Value of dropdown list Neurological
67 Manual
67 Manual
67 Manual
67 Manual
67 Manual
67 Manual
67 Manual
68 Manual Course in the Ward section
68 Manual
68 Manual
68 Manual
68 Manual
68 Manual
68 Manual
Button + Add at Course in the Ward

69 Manual
section
69 Manual
69 Manual
69 Manual
69 Manual
69 Manual
69 Manual
MEDICINE ( List of Prescribed Drugs

70 Manual
to the Patient ) section
70 Manual
70 Manual
70 Manual
70 Manual
70 Manual
70 Manual
Button + Add at MEDICINE ( List of

71 Manual Prescribed Drugs to the Patient )
section
71 Manual
71 Manual
71 Manual
71 Manual
71 Manual
71 Manual
72 Manual 6. Requirements tab
72 Manual
72 Manual
72 Manual
Button Click Here To Add Receipt at

72 Manual Receipts section of Requirements
tab
72 Manual
72 Manual
72 Manual
72 Manual
72 Manual
73 Manual ATTACHMENT/S TO SUBMIT section
73 Manual
73 Manual
73 Manual
73 Manual
74 Manual PREVIOUS ATTACHMENT/S section
74 Manual
74 Manual
74 Manual
74 Manual
72 Manual 7. Summary tab
72 Manual
72 Manual
72 Manual
Description Priority Action Data
Pre-condition: Login EClaims tab successfully

Login to Carespan system with
High
Doctor role
Verify Claims tab display on the menu
Click on Eclaims tab

Observe the result

High
Verify Claims tab display when not has any Doctor role
claim
Click on Eclaims tab and make sure

there is no claim
Observe the result

High
Doctor role
Verify Claims tab display when has any claim

there is at least one claim
Observe the result

High
Doctor role
Verify items on Claims tab

Observe at Claims

High
Doctor role
Verify button More + at Claims tab

Click button More + at Claims tab

High
Doctor role
Verify items on For Filing Claims tab

Click on For Filing Claims tab

High
Doctor role
Verify items on Refiled Claims tab
Click on Refiled Claims tab

High
Doctor role
Verify click on button Create New Claim
Click on button Create New Claim

High
Doctor role
Verify items on Eligibity tab

Click on 1. Eligibity tab

High
Verify screen after clicking button Back to Doctor role
Check Eligibility

Click on 1. Eligibity tab
Click on button Back to Check
Eligibility

High
Doctor role
Verify screen after clicking 2. CF1 tab

Click on 2. CF1 tab

High
Verify items at General Details section of 2. Doctor role
CF1 tab

Click on 2. CF1 tab
Observe items at General Details


High
Verify items at Member Information section Doctor role
of 2. CF1 tab

Click on 2. CF1 tab
Observe items at Member

Information section of 2. CF1 tab

High
Verify items at Member's Address Doctor role

Click on 2. CF1 tab
Observe items at Member's Address

High
Verify items at Patient Information section of Doctor role
2. CF1 tab

Click on 2. CF1 tab
Observe items at Patient


High
Verify items at Employer Information section Doctor role
of 2. CF1 tab

Click on 2. CF1 tab
Observe items at Employer

High
Doctor role

Click on 3. CF2 tab

High
Verify items of Confinement Information Doctor role

Click on 3. CF2 tab
Observe at Confinement
Information section

High
Verify items of Diagnosis section of 3. CF2 Doctor role
tab
Click on 3. CF2 tab
Observe at Diagnosis section

High
Verify when clicking Button + Add RVS at Doctor role
Diagnosis section of 3. CF2 tab

Click on 3. CF2 tab
Click button Button + Add RVS at

Diagnosis section

High
Verify when clicking Button + Add discharge Doctor role
Diagnosis at Diagnosis section of 3. CF2 tab

Click on 3. CF2 tab
Click button + Add discharge

Diagnosis at Diagnosis section

High
Verify items of Case Rates section of 3. CF2 Doctor role
tab

Click on 3. CF2 tab
Observe at Case Rates section

High
Verify when clicking button + Add at Case Doctor role
Rates section of 3. CF2 tab

Click on 3. CF2 tab
Click button + Add at Case Rates

section

High
Verify items of Special Considerations section Doctor role
of 3. CF2 tab

Click on 3. CF2 tab
Observe at Special Considerations

section

High
Verify when clicking button + Add at Special Doctor role
Considerations section of 3. CF2 tab

Click on 3. CF2 tab
Click button + Add at Special
Considerations section

Verify items of For MCP (Enumerate four High
Doctor role
dates (mm-dd-yyyy) of pre-natal check-ups)

Click on 3. CF2 tab
Observe at For MCP (Enumerate
four dates (mm-dd-yyyy) of pre-
natal check-ups) section

High
Doctor role
For TB DOTS Package section of 3. CF2 tab

Click on 3. CF2 tab
Observe at For TB DOTS Package

section

For Animal Bite Package (Write the dates High
Doctor role
(mm-dd-yyyy) when the following doses of
vaccine were given) section of 3. CF2 tab

Click on 3. CF2 tab
Observe at For Animal Bite Package
(Write the dates (mm-dd-yyyy)
when the following doses of vaccine
were given) section

High
Doctor role
Newborn Care Details section of 3. CF2 tab

Click on 3. CF2 tab
Observe at Newborn Care Details

section

High
HIV/AIDS Treatment Details section of 3. CF2 Doctor role
tab

Click on 3. CF2 tab
Observe at HIV/AIDS Treatment

Details section

High
Cataract Treatment Details section of 3. CF2 Doctor role
tab

Click on 3. CF2 tab
Observe at Cataract Treatment

Details section

High
Verify items of Professional Fees / Charges Doctor role

Click on 3. CF2 tab
Observe at Professional Fees /

Charges section

High
Verify items of Certification of Consumption Doctor role
of Benefits section of 3. CF2 tab

Click on 3. CF2 tab
Observe at Certification of
Consumption of Benefits section
Verify items of Total Health Care Institution Login to Carespan system with
High
Fee section when selecting No at radio Doctor role
button Enough Benefits at Certification of

Click on 3. CF2 tab
Select No at radio button Enough
Benefits at Certification of
Observe Total Health Care

Institution Fee section just display
Verify items of Total Professional Fee section Login to Carespan system with
High
when selecting No at radio button Enough Doctor role
Benefits at Certification of Consumption of
Benefits section

Click on 3. CF2 tab
Observe Total Professional Fee

section just display
Verify items of Purchases/Expenses NOT

included in the HCI charges section when High
Doctor role
selecting No at radio button Enough Benefits
at Certification of Consumption of Benefits
section

Click on 3. CF2 tab
Observe Purchases/Expenses NOT

included in the HCI charges section
just display

High
Verify items of Access Patient Record section Doctor role
of 3. CF2

Click on 3. CF2 tab
Observe Access Patient Record

section

Verify items when selecting "Patient" at High
Doctor role
dropdown list Signed By of Access Patient
Record section of 3. CF2

Click on 3. CF2 tab
Go to Access Patient Record section
Select "Patient" at dropdown list
Signed By

Verify items when selecting "Representative" High
Doctor role
at dropdown list Signed By of Access Patient

Click on 3. CF2 tab
Select "Representative" at
dropdown list Signed By

Verify items when selecting "Thumbmark" at High
Doctor role
dropdown list Signed By of Access Patient

Click on 3. CF2 tab
Select "Thumbmark" at dropdown
list Signed By

High
Doctor role

Click on 4. CF3 tab

High
Verify when selecting "No" at radio button Doctor role
Availed Maternity Care Package? At CF3 tab

Click on 4. CF3 tab
Select "No" at Availed Maternity

Care Package

High
Verify when selecting "Yes" at radio button Doctor role
Availed Maternity Care Package? At CF3 tab

Click on 4. CF3 tab
Select "Yes" at Availed Maternity
Care Package
Verify items of Consultation Information Login to Carespan system with

High
section when selecting "Yes" at radio button Doctor role
Availed Maternity Care Package? At CF3
screen

Click on 4. CF3 tab
Care Package
Observe items of Consultation

Information section
Verify items of Complaints Information Login to Carespan system with

High
screen

Click on 4. CF3 tab
Care Package
Observe items of Complaints
Information section

Verify items of Maternity Details section High
Doctor role
when selecting "Yes" at radio button Availed
Maternity Care Package? At CF3 screen

Click on 4. CF3 tab
Care Package
Observe items of Maternity Details

section
Verify items of Obstetric History section High
Doctor role

Click on 4. CF3 tab
Care Package
Observe items of Obstetric History

section

Verify items of Medical Surgery section when High
Doctor role
selecting "Yes" at radio button Availed

Click on 4. CF3 tab
Care Package
Observe items of Medical Surgery

section
Verify items of Delivery Information section High
Doctor role

Click on 4. CF3 tab
Care Package
Observe items of Delivery

Information section
Verify items of Post Partrum Information Login to Carespan system with

High
screen

Click on 4. CF3 tab
Care Package
Observe items of Post Partrum
Information section
Verify items of Post Partrum Information Login to Carespan system with

High
screen

Click on 4. CF3 tab
Care Package
Observe items of Post Partrum

Information section
Verify when clicking button "Click Here To High
Doctor role
Add Drug Medicine" of Drug Medicine
section of CF3 screen

Click on 4. CF3 tab
Go to Drug Medicine section
Click button "Click Here To Add
Drug Medicine"
Observe the result

High
Verify when clicking button "Click Here To Doctor role
Add XLSOS" of XLSOS section of CF3 screen

Click on 4. CF3 tab
Go to XLSOS section
Click button "Click Here To Add
XLSOS"
Observe the result

High
Doctor role

Click on 5. CF4 tab

High
Verify when select "Yes" at radio button Doctor role
Should include CF4 of CF4 screen

Click on 5. CF4 tab
Select "Yes" at radio button Should

include CF4

High
Verify items of PROFILING - Health Screening Doctor role
& Assessment section when select "Yes"

Click on 5. CF4 tab
include CF4
Observe at PROFILING - Health
Screening & Assessment section

High
Verify items of Chief Complaint section when Doctor role
select "Yes"

Click on 5. CF4 tab
include CF4
Observe at Chief Complaint section

High
Verify items of Reason for Admission section Doctor role
when select "Yes"

Click on 5. CF4 tab
include CF4
Observe at Reason for Admission

section

High
Verify items of OB/GYN History (For female Doctor role
Patient Only) section when select "Yes"

Click on 5. CF4 tab
include CF4
Observe at OB/GYN History (For

female Patient Only) section

High
Patient Only) section
Click on 5. CF4 tab
include CF4
Observe at Pertinent Signs and

Symptoms on Admission section

High
Patient Only) section

Click on 5. CF4 tab
include CF4
Observe at Physical Examination on

Admission (Pertinent Findings per
System) section
Verify items of PEPERT (Physical Examination Login to Carespan system with

High
Findings for BP Measurements, Heart and Doctor role
Respiratory Rate, Body Measurements and
Vision) section

Click on 5. CF4 tab
include CF4
Observe at PEPERT (Physical
Examination Findings for BP
Measurements, Heart and
Respiratory Rate, Body
Measurements and Vision) section
Verify items of PEMISC (Physical Examination Login to Carespan system with

High
Findings for Skin, Heent, Chest, Heart, Doctor role
Abdomen, Neuro, Rectal and Genitourinary)
section

Click on 5. CF4 tab
include CF4
Observe at PEMISC (Physical

Examination Findings for Skin,
Heent, Chest, Heart, Abdomen,
Neuro, Rectal and Genitourinary)
section
Verify value of dropdown list Heent

Description of PEMISC (Physical Examination High
Doctor role
Findings for Skin, Heent, Chest, Heart,
section and logic

Click on 5. CF4 tab
include CF4
go to PEMISC (Physical Examination

Select all value at dropdown list
Heent Description
Verify value of dropdown list Chest/Lungs

Doctor role
section and logic

Click on 5. CF4 tab
include CF4


Chest/Lungs Description
Verify value of dropdown list CVS/Heart

Doctor role
section and logic

Click on 5. CF4 tab
include CF4

CVS/Heart Description
Verify value of dropdown list Abdomen

Doctor role
section and logic

Click on 5. CF4 tab
include CF4


Abdomen Description
Verify value of dropdown list Abdomen

Doctor role
section and logic

Click on 5. CF4 tab
include CF4


Genitourinary Description
Verify value of dropdown list Skin /

Extremities Description of PEMISC (Physical High
Doctor role
Examination Findings for Skin, Heent, Chest,
Genitourinary) section and logic

Click on 5. CF4 tab
include CF4


Skin / Extremities Description
Verify value of dropdown listNeurological

Doctor role
section and logic

Click on 5. CF4 tab
include CF4


Neurological Description

High
Doctor role
Verify items of Course in the Ward section

Click on 5. CF4 tab
include CF4
go to Course in the Ward section
Observe the result

High
Verify when clicking button + Add at Course Doctor role
in the Ward section
Click on 5. CF4 tab
include CF4
go to Course in the Ward section
Click button + Add

High
Verify items ofMEDICINE ( List of Prescribed Doctor role
Drugs to the Patient ) section

Click on 5. CF4 tab
include CF4
go to MEDICINE ( List of Prescribed

Observe the result

Verify when clicking button + Add at High
Doctor role
MEDICINE ( List of Prescribed Drugs to the
Patient ) section

Click on 5. CF4 tab
include CF4
go to MEDICINE ( List of Prescribed

Click button + Add

High
Verify screen after clicking 6. Requirements Doctor role
tab

Click on 6. Requirements tab

High
Verify when clicking button Click Here To Add Doctor role
Receipt at Receipts section

Go to Receipts section
Click button Click Here To Add

Receipt
High
Verify items of ATTACHMENT/S TO SUBMIT Doctor role
section

Go to ATTACHMENT/S TO SUBMIT
section

High
Verify items of PREVIOUS ATTACHMENT/S Doctor role
section

Go to PREVIOUS ATTACHMENT/S
section

High
Doctor role
Verify screen after clicking 7. Summary tab

Click on 7. Summary tab
Expected Result
Display Claims tab on menu
Display Claims tab with:

+ Title: No claims yet
+ Content: Start claiming! Encode and send directly to PhilHealth. Also, if you’re
having a hard time encoding you may reach out to our Chat Support for
assistance.
+ Button CREATE A CLAIM

+ Claims tab
+ For Filing Claims
+ Refiled Claims
+ Status filter: All Status, In Process, Returned, Denied and Draft
+ Dropdown list Filter Date by: Date Updated, Date Created, Date Submiited,
Admission Date and Discharge Date
+ Date picker Discharge Date
+ Button More +
+ Search textbox
+ Button Update Claim
+ Button Filter
+ Button Excel
+ Print
+ Button Bulk Export
+ A grid with columns: checkbox tick, Status, PHIC Series Num, Member PIN,
Member Type, Member Name, Patient Name, Date Created, Days before lapse,
Transmittal Age, Admission Date, Discharged, ICD10, Operation Performed, RVS,
Submitted By and Refiled Date
Display 2 more field:

+ Dropdown list Additional Filter By: Discharge Diagnosis, Procedures, Case Rates,
ICD Code and Membership Type
+ Dropdown list Membership Type: Select Membership Type, Employed Private,
Employer Government, Indigent, Individually Paying, OFW, Non Paying Private,
Non Paying Government and Lifetime Member
Display For Filing Claims tab with:

+ Search textbox
+ Datepicker Date Created
+ a grid with columns: Status, PHIC Series Num, Member PIN, Member Type,
Member Name, Patient Name, Date Created, Days before lapse, Transmittal Age,
Admission Date, Discharged, ICD10, Operation Performed, RVS, Submitted By and
Refiled Date
+ Button Excel and Print
Display Refiled Claims tab with:
+ Search textbox
+ Datepicker Date Created
+ a grid with columns: Status, PHIC Series Num, Member PIN, Member Type,
Member Name, Patient Name, Date Created, Days before lapse, Transmittal Age,
Admission Date, Discharged, ICD10, Operation Performed, RVS, Submitted By and
Refiled Date
+ Button Excel and Print
Display screen with these tab:

1. Eligibility
2. CF1
3. CF2
4. CF3
5. CF4
6. Requirements
7. Summary
Display 1. Eligibity tab include:

+ Button Back to Check Eligibity tab
+ Title: Benefit Eligibigity
+ Button Discard Claim
+ Information of:
- HCI Portal Information: HCI Portal Reference No and Date & Date of Generation
- Health Care Institution (HCI) Information: Name of Institution and Accreditaion
No
- Member Information: Philhealth Identification No, Name of Member, Date of
birth and Member Category
- Patient Information: Name of Patient, Date Admitted and Date of Birth
- Eligibility Information: ELIGIBLE TO AVAIL PHILHEALTH? = , Reason/s
- Documents to attach
+ Button Save As Draft, Print and Next
Include 2 section:
+ Member Information section:
- PIN texbox (Required field)
- Last Name textbox (Required field)
- First Name textbox (Required field)
- Middle Name
- Dropdown list Suffix Name: Sr, I, Jr, II,III, IV, V, VI, VII, VIII, IX, X, XI, XII, XIII, Sr., Jr.
- Date picker Date of Birth (Required field)
- Dropdown list Member Type: 'S' - Employed Private, 'G' - Employed
Government, 'I' - Indigent, 'NS' - Individually Paying, 'NO' - OFW, 'PS' - Non Paying
Private, 'PG' - Non Paying Government and 'P' - Lifetime Member
- Radio button Patient is a member?: Yes or No
+ Confinement Information section:
- Datepicker Admission Date (Required field)
- Datepicker Discharged Date (Required field)
- Total Amount Actual textbox (Required field)
- Total Amount claimed (Required field)
- Radio button Final? (Required field) with Yes or No
- Tickbox with content: Automatically Removes whitespace from both ends of a
string in the form
+ Button Submit
Include these section:

+ General Details section:
+ Member Information section:
+ Member's Address Information
+ Patient Information
+ Employer Information
General Details section of 2. CF1 tab include:
- Tracking Number textbox (Required field)
- Radio button Claim Type (Required field): All Rates or Z-Type
- Radio button Patient Type (Required field): Inpatient or Outpatient
- Radio butotn Emergency Case (Required field): Yes or No
Member Information section of 2. CF1 tab include:

- Radio button Member Information (Required field): Male or Female
- PIN textbox (Required field)
- Dropdown list Membership Type (Required field): 'S' - Employed Private, 'G' -
Employed Government, 'I' - Indigent, 'NS' - Individually Paying, 'NO' - OFW, 'PS' -
Non Paying Private, 'PG' - Non Paying Government and 'P' - Lifetime Member
- Middle Name textbox (Required field)
- Datepicker Date of Birth (Required field)
- Mobile number textbox
- Email Address textbox
- Telephone Number textbox
Member's Address Information section of 2. CF1 tab include:
- Street textbox
- Subdivision textbox
- Building Name textbox
- Building Number textbox
- Room Number textbox
- Barangay textbox (Required field)
- City textbox (Required field)
- Province textbox (Required field)
- Country textbox (Required field)
- Zip Code textbox (Required field)
- Button Reset address details
Patient Information section of 2. CF1 tab include:

- Radio button Gender (Required field): Male or Female
- Nofity content: IMPORTANT: Use member's PIN Number if the dependent does
not have an assigned PhilHealth PIN.
- PIN textbox (Required field)
- Dropdown list Membership Type (Required field): 'S' - Employed Private, 'G' -
Employed Government, 'I' - Indigent, 'NS' - Individually Paying, 'NO' - OFW, 'PS' -
Non Paying Private, 'PG' - Non Paying Government and 'P' - Lifetime Member
- Middle Name textbox (Required field)
- Datepicker Date of Birth (Required field)
- Mobile number textbox
- Email Address textbox
- Telephone Number textbox
Employer Information section of 2. CF1 tab include:
- PEN textbox (Required field)
- Employer Name texbox
- Button Search employer details
- Button Save As Draft
- Button Back
- Button Next
Include these section:

+ Confinement Information section
+ Diagnosis section
+ Case rate section
+ Special Considerations section
+ Professional Fees / Charges section
+ Certification of Consumption of Benefits section
+ Access Patient Record section
Confinement Information section include:

+ Datepicker Admission Date (Required field)
+ Timepicker Admission Time (Required field)
+ Datepicker Discharge Date (Required field)
+ Timepicker Discharge Time (Required field)
+ Dropdown list Disposition: Improved, Recovered, Home/Discharged Against
Medical Advise, Absconded, Expired and Transerred/Referred
+ Radio button Patient Referred (Required field): Yes or No
+ Referral Facility Accreditation Code textbox
+ Reason/s for referral/transfer textbox
+ Radio button Accommodation Type (Required field): Private or Non-Private
+ Radio button SOA (Required field): With attached SOA and Without attached
SOA
Diagnosis section include:
+ Dropdown list Admission Diagnosis (Required field)
+ Button Copy
+ Dropdown list ICD10 (Required field)
+ Text area Discharge Diagnosis (Required field)
+ Button Add RVS
+ Button Add discharge Diagnosis
Display these fields:

+ Dropdown list RVS Code (Required field)
+ Related Procedures textbox (Required field)
+ Datepicker Date of Procedure (Required field)
+ Dropdown list Laterality (Required field): N/A, Left, Right and Both
+ Action: icon trash

+ Dropdown list ICD10 (Required field)
+ Text area Discharge Diagnosis (Required field)
Case Rates section include:

+ A grid with colums: #, CR Code, Type, Code/s and Amount
+ Button + Add
Display these field
+ Radio button Type (Required field): ICD10 or RVS
1. When select ICD10
- Dropdown list ICD10 Code (Required field)
- Case Rate Code textbox (Required field)
- Dropdown list Amount (Required field)
2. When select RVS
- Dropdown list RVS Code (Required field)
- Case Rate Code textbox (Required field)
- Dropdown list Amount (Required field)
+ Button Save and Cancel
Case Rates section include:

+ A grid with colums: Procedure, Session/s
+ Button + Add
Display these field:
+ Dropdown list Procedures (Required field): Brachytherapy, Chemotherapy,
Debridement, Hemedialysis, Imrt, Peritoneal, Radiotherapy (LINAC),
Radiotherapy (COBALT) and Tranfusion
+ Increament button Add Multiple Sessions
+ Total Sessions Added (Count for Add multiple Sessions)
+ Datepicker for Session
+ Button + Add session date: add one more session datepicker
+ Button Save and Cancel
Radio button Availed MPC package: Yes or No

- If click Yes display more fields: 4 datepickers
Radio button Availed TB DOTS package?: Yes or No

- If click Yes display more fields:
+ Dropdown list Type: Intensive Phase or Maintenance
+ Card Number textbox
Radio button Availed animal bite package?: Yes or No
+ Datepicker Day 0 ARV, Day 3 ARV, Day 7 ARV, RIG, Others Date and
Others(Specify)
Radio button Availed newborn care package?: Yes or No

+ Radio button Essential Newborn Care: Yes or No (If click No will just display 3
radio button Essential Newborn Care, Newborn Hearing Screening Test and
Newborn Screening Test , If click Yes will display all radio buttons)
+ Radio button Newborn Hearing Screening Test: Yes or No
+ Radio button Newborn Screening Test: Yes or No (If click Yes will display Filter
Card Number textbox (Required field), if no will disspear this field)
+ Radio button Immediate drying: Yes or No
+ Radio button Early skin-to-skin contact: Yes or No
+ Radio button Timely cord clamping: Yes or No
+ Radio button Eye prophylaxis: Yes or No
+ Radio button Weighing of the newborn: Yes or No
+ Radio button Vitamin K administration: Yes or No
+ Radio button BCG vaccination: Yes or No
+ Radio button Non-separation of mother/baby for early breastfeeding initiation:
Yes or No
+ Radio button Hepatitis B vaccination: Yes or No
Radio button Availed HIV/AIDS treatment package?: Yes or No

- If click Yes display more field:
+ Laboratory Number textbox (Required field)
Radio button Availed HIV/AIDS treatment package?: Yes or No
- If click Yes display more field:
+ Pre-Authentication Number textbox
+ Datepicker Left Eye IOL Expiry Date
+ Left Eye IOL Sticker Number textbox
+ Datepicker Right Eye IOL Expiry Date
+ Right Eye IOL Sticker Number textbox
Display Professional Fees / Charges section include:

+ Title: Attending Physician
+ Dropdown list Accreditation Number
+ Doctor's Last Name textbox (Required field)
+ Doctor's First Name textbox (Required field)
+ Doctor's Middle Name textbox
+ Dropdown list Doctor's Suffix Name: Sr, I, Jr, II,III, IV, V, VI, VII, VIII, IX, X, XI, XII,
XIII, Sr., Jr.
+ Radio button With Co-pay (Required field): Yes or No (if click Yes will display
more field Co-Pay Amount texbox)
+ Datepicker Date Signed (Required field)
Display Certification of Consumption of Benefits section include:

+ Dropdown list Enoung Benefits (Required field): Yes or No
1. If click No will display more:
- Total Health Care Institution Fee section
- Total Professional Fee section
- Purchases/Expenses NOT included in the HCI charges section
2. If click Yes will display more:
- Total Health Care Institution Fees textbox (Required field)
- Total Professional Fees textbox
- Grand Total textbox
Display Total Health Care Institution Fee section include:
+ Total Actual Charges textbox
+ Amount after Application of Discount textbox
+ PhilHealth Benefit textbox
+ Amount after PhilHealth Deduction = Amount after Application of Discount -
PhilHealth Benefit
+ Checkbox Paid By (Required field): Member/PAtient, HMO and Others
Display Total Professional Fee section include:

+ Total Actual Charges textbox
+ Amount after Application of Discount textbox
+ PhilHealth Benefit textbox
+ Amount after PhilHealth Deduction = Amount after Application of Discount -
PhilHealth Benefit
+ Checkbox Paid By (Required field): Member/PAtient, HMO and Others
Display Purchases/Expenses NOT included in the HCI charges section include:
+ Radio button Patient purchased drug/medicines and/or medical supplies?
(Required field): Yes or No (If click Yes will display more field Total Amoun
textbox)
+ Radio button Patient paid diagnostic/laboratory examinations? (Required field):
Yes or No (If click Yes will display more field Total Amoun textbox)
Display Access Patient Record section include:

+ Dropdowm list Signed By (Required field): Patient, Representative and
Thumbmark
+ Dropdown list Relationship to the patient (Required field): Self, Spouse, Child,
Parent, Sibling and Others
Thumbmark
Parent, Sibling and Others (Just can select Self)

Thumbmark
+ Radio button Signing Reason: Patient is incapacitated and Other reasons (If
select Other reasons will display more field Reason Description textbox)
Thumbmark
+ Radio button Thumbmarked By (if patient/representative can write): Patient or
Representative
+ Radio button Signing Reason: Patient is incapacitated and Other reasons (If
select Other reasons will display more field Reason Description textbox)
Display CF3 screen include:

+ Radio button Availed Maternity Care Package?: Yes or No
+ Drug Medicinet section
+ XLSOS section
Display screen include:

+ XLSOS section
Display screen include:
+ Consultation Information section
+ Complaints Information section
+ Maternity Details section
+ Obstetric History section
+ Medical Surgery section
+ Delivery Information section
+ Post Partrum Information section
+ XLSOS section
Consultation Information section include:

+ Datepicker Date of visit
+ AOG in weeks textbox
+ Weight textbox
+ Cardiac Rate textbox
+ Respiratory Rate textbox
+ Blood Pressure textbox
+ Temperature textbox
+ Button + Add consultation information
Complaints Information section include:
+ Chief Complaint or Reason for Admission text area (Required field)
+ Brief History(OB Score/OB History) text area (Required field)
+ Course in the Wards text area (Required field)
+ Pertinent Laboratory and Diagnostic Findings text area (Required field)
+ BP - Blood Pressure textbox
+ CR textbox
+ RR - Respiratory Rate textbox
+ Temperature textbox
+ HEENT - Head, Ears, Eyes, Nose and Throat textbox
+ Chest/Lungs textbox
+ CVS textbox
+ Abdomen textbox
+ GUIE textbox
+ Skin Extremities textbox
+ Neuro Examination textbox
Maternity Details Information section include:

+ Radio button Vital Signs are Normal: Yes or No
+ Radio button Ascertain the Present. Pregnacy is low-risk: Yes or No
+ Radio button Orientation to MCP/Availment of Benefits: Yes or No
+ Datepicker Initial Prenatal Consultation
+ Datepicker Expected date of delivery
+ Datepicker Last Menstrual Period
+ Age of Menarche textbox
+ Obstetric G textbox
+ Obstetric P textbox
+ Obstetric_T textbox
+ Obstetric_P textbox
+ Obstetric_A textbox
+ Obstetric_L textbox
Obstetric History section include these radio buttons with Yes or No:
+ Multiple Pregnancy
+ Ovarian Cyst
+ Myoma Uteri
+ Placenta Previa
+ History of 3 miscarriages
+ History of stillbirth
+ History of pre-eclampsia
+ History of eclampsia
+ Premature contraction
Medical Surgery section include these radio buttons with Yes or No:
+ Hypertension
+ Heart Disease
+ Diabetes
+ Thyroid Disorder
+ Obesity
+ Moderate to severe asthma
+ Epilepsy
+ Renal Disease
+ Bleeding disorders
+ History of previous caesarian section
+ History of uterine myomectomy
Delivery Information section include:
+ Datepicker Date of Delivery
+ Timepicker Time of Delivery
+ Obstetric Index textbox
+ AOG by LMP textbox
+ Manner of Delivery textbox
+ Presentation textbox
+ Fetal Outcome textbox
+ Radio button Sex: Male or Female
+ Birth Weight (gram) textbox
+ APGAR Score textbox
+ Datepicker Scheduled Postpatrum follow-up consultation
Post Partrum Information section include:
+ Radio button Perineal wound care: Yes or No and Remarks
+ Radio button Signs of Maternal Postpatrum Complications: Yes or No and
Remarks
+ Radio button Breastfeeding and Nutrition: Yes or No and Remarks
+ Radio button Family Planning: Yes or No and Remarks
+ Radio button Provided family planning service to patient (as requested by
patient): Yes or No and Remarks
+ Radio button Referred to partner physician for Voluntary Surgical Sterilization
(as requested by patient): Yes or No and Remarks
+ Radio button Schedule the next postpartum follow-up: Yes or No and Remarks
+ Radio button Completed Intensive Phase: Yes or No
+ Radio button Completed Maintenance Phase: Yes or No
+ Reason for referral from other HCI textbox
+ Clinical Criteria and/or Laboraties/Diagnositics Criteria textbox
Post Partrum Information section include:

+ Radio button Perineal wound care: Yes or No and Remarks
+ Radio button Signs of Maternal Postpatrum Complications: Yes or No and
Remarks
+ Radio button Breastfeeding and Nutrition: Yes or No and Remarks
+ Radio button Family Planning: Yes or No and Remarks
+ Radio button Provided family planning service to patient (as requested by
patient): Yes or No and Remarks
+ Radio button Referred to partner physician for Voluntary Surgical Sterilization
(as requested by patient): Yes or No and Remarks
+ Radio button Schedule the next postpartum follow-up: Yes or No and Remarks
+ Radio button Completed Intensive Phase: Yes or No
+ Radio button Completed Maintenance Phase: Yes or No
+ Reason for referral from other HCI textbox
+ Clinical Criteria and/or Laboraties/Diagnositics Criteria textbox
+ Datepicker Date of Purchased (Required field)
+ Hospital Assigned Drug Code textbox (Required field)
+ PNDF Code textbox (Required field)
+ Generic Name textbox (Required field)
+ Brand Name textbox (Required field)
+ Preparation textbox (Required field)
+ Quantity textbox (Required field)

+ Datepicker Date of Diagnostic (Required field)
+ Diagnostic Name textbox (Required field)
+ Unit quantity of item textbox (Required field)
+ Dropdown list Type of diagnostic/test done (Required field): IMAGING,
LABORATORY, SUPPLIES and OTHERS
Display CF4 screen include:

+ Radio button Should include CF4?: Yes or No (Default selection is No and notify
message "Cf4 is not required. You can proceed to the next step."
Display these sections:
+ PROFILING - Health Screening & Assessment
+ Chief Complaint
+ Reason for Admission
+ OB/GYN History (For female Patient Only)
+ Pertinent Signs and Symptoms on Admission
+ Physical Examination on Admission (Pertinent Findings per System)
+ PEPERT (Physical Examination Findings for BP Measurements, Heart and
Respiratory Rate, Body Measurements and Vision)
+ PEMISC (Physical Examination Findings for Skin, Heent, Chest, Heart, Abdomen,
Neuro, Rectal and Genitourinary)
+ COURSE IN THE WARD
+ MEDICINE ( List of Prescribed Drugs to the Patient )
Display PROFILING - Health Screening & Assessment section include:

+ Datepicker Profiling Date (Required field)
Display Chief Complaint section include:

+ Patient Chief Complaint text area (Required field)
Display Reason for Admission section include:
+ History of Patient Illnesses text area (Required field)
+ Pertinent Past Medical History text area (Required field)
Display OB/GYN History (For female Patient Only) section include:

+ Radio button Is Applicable?: Yes or No
- If click Yes will display 2 section with more fields:
1. Patient Menstrual History
+ Date picker Last Menstrual Period
2. Patient Pregnancy History
+ No. of Pregnancy to Date textbox
+ No. of Delivery to Date textbox
+ Number of Full Term Pregnancy textbox
+ Number of Premature Pregnancy textbox
+ Number of Abortion textbox
+ Number of Living Children textbox
Display Pertinent Signs and Symptoms on Admission section include:
+ Dropdown list multiple choice: ALTERED MENTAL SENSORIUM, ABDOMINAL
CRAMP/PAIN, ANOREXIA, BLEEDING GUMS, BODY WEAKNESS, CONSTIPATION,
BLURRING OF VISION, CHEST PAIN/DISCOMFORT, COUGH, DIARRHEA, DIZZINESS,
DYSPHAGIA, DYSURIA, EPISTAXIS, FREQUENCY OF URINATION, HEMATEMESIS,
HEADACHE, HEMATURIA, HEMOPTYSIS, IRRITABILITY, JAUNDICE, LOWER
EXTREMITY EDEMA, MYALGIA, ORTHOPNEA, PALPITATIONS, SKIN RASHES,
STOOL, BLOODY/BLACK TARRY/MUCOID, SWEATING, SEIZURES, URGENCY,
VOMITING/NAUSEA. WEIGHT LOSS, FEVER, PAIN and OTHERS
+ Pain Site textbox (Required field) with note: Site of Pain if Pain Element in
Pertinent Signs and Symptoms on Admission is checked
+ Other Complaint textbox (Required field)
Display Physical Examination on Admission (Pertinent Findings per System)

section include:
+ Radio button General Survey (Required field): Awake and Alert , Altered
Sensorium (If select Altered Sensorium will display Remarks for Altered
Sensorium textbox)
Display PEPERT (Physical Examination Findings for BP Measurements, Heart and
Respiratory Rate, Body Measurements and Vision) section include:
+ Systolic Blood Pressure of Patient –mmHG textbox (required field)
+ Diastolic Blood Pressure of Patient textbox (required field)
+ Heart Rate of Patient per Minute textbox (required field)
+ Respiratory Rate of Patient per Minute textbox (required field)
+ Temperature in Celsius textbox (required field)
Display PEMISC (Physical Examination Findings for Skin, Heent, Chest, Heart,
Abdomen, Neuro, Rectal and Genitourinary) section include:
+ Dropdown list multiple choice Heent Description
+ Dropdown list multiple choice Chest/Lungs Description
+ Dropdown list multiple choice CVS/Heart Description
+ Dropdown list multiple choice Abdomen Description
+ Dropdown list multiple choice Genitourinary Description
+ Dropdown list multiple choice Skin / Extremities Description
+ Dropdown list multiple choice Neurological Description
+ Dropdown list multiple choice Heent Description: Essentially normal,
Abnormal pupillary reaction, Drymucous membrane, Cervical lympadenopathy,
Icteric sclerae, Pale conjunctivae, Sunken eyeballs, Sunken fontanelle and Others
(When select Essentially normal will just display this value and clear all, if select
Others will display more field textbox Additional Findings in Heent)
+ Dropdown list multiple choice Chest/Lungs Description: Essentially normal,

Lumps over breast(s), Retractions, Cracles/rales, Wheezes, Asymmetrical chest
expansion, Decreased breath sounds and Others
Others will display more field textbox Additional Findings in Chest/Lungs)
+ Dropdown list multiple choice CVS/Heart Description: Essentially normal,
Lumps over breast(s), Retractions, Cracles/rales, Wheezes, Asymmetrical chest
expansion, Decreased breath sounds and Others
Others will display more field textbox Additional Findings in Heart)
+ Dropdown list multiple choice Abdomen Description: Essentially normal,

Hyperactive bowel sounds, Palpable mass(es), Tympanitic/dull abdomen, Uterine
contraction, Abdominal rigidity, Abdominal tenderness and Others
Others will display more field textbox Additional Findings in Abdomen)
+ Dropdown list multiple choice Genitourinary Description: Essentially normal,
Blood stained in exam finger, Cervical dilatation, Presence of abnormal discharge
and Others
Others will display more field textbox Additional Findings in Genitourinary)
+ Dropdown list multiple choice Skin / Extremities Description: Essentially

normal, Weak pulses, Clubbing, Cold clammy, Cyanosis/mottled skin,
Edema/swelling, Decreased mobility, Pale nailbeds, Poor skin turgor,
Rashes/Petechiae and Others
Others will display more field textbox Additional Findings in Skin / Extremities)
+ Dropdown list multiple choice Neurological Description: Essentially normal,
Abnormal reflex(es), Poor/altered memory, Poor muscle tone/strength, Poor
coordination, Abnormal gait, Abnormal position sense, Abnormal sensasion and
Others
Others will display more field textbox Additional Findings inNeurological )
Display Course in the Ward section include:

+ Title: List of Actions/Order by Doctor
+ A grid with columns: Date and Action / Order by Doctor
+ Butotn + Add
Display pop-up Order / Action by Doctor with these fields:
+ Datepicker Date (Required field)
+ Enter Action/Order by Doctor text area
+ Button Cancel and Save
Display Course in the Ward section include:

+ A grid with columns: Generic Name, Quantity / Frequency / Route and Total
Cost
+ Butotn + Add
Display pop-up Medicine / Drug with these fields:
+ Dropdown list Drug Description (Required field)
+ Generic Name of Medicine textbox (Required field)
+ Medicine Route textbox (Required field)
+ Number of Medicines Prescribed textbox (Required field)
+ Instruction Frequency textbox (Required field)
+ Total Amount Price of Medicine Issued textbox (Required field)
+ Button Cancel and Save
Display Requirements screen include:

+ Title: For generating Claim Forms, kindly use the download links provided
below:
+ Receipts section
+ ATTACHMENT/S TO SUBMIT section
+ PREVIOUS ATTACHMENT/S section
Display pop-up include these fields:

+ Company's Name textbox
+ Company’s TIN
+ BIR Permit Number
+ Official Receipt Number
+ Datepicker Official Receipt Date
+ VAT Exempt Sale
+ VAT – 12%
+ Total Amount
+ Quantity
+ Unit Price of Item
+ Item Description
+ Total Amount
+ Button + Add item
Display ATTACHMENT/S TO SUBMIT section include:
+ Text: Additional Required Documents
+ Text: Claim Signature Form
+ Text: Claim Form 4 System generated from CF4 Page.
+ Text: Claim Form 2
+ Text: Statement of Account
+ Text: Certificate of Eligibility
+ Upload folder (Maximum upload per file size: 2MB.)
Display Summary screen include: all the information take from previous screen:
1. SUMMARY tab
+ Hospital Transmittal ID
+ Tracking Number, Patient Type, Claim Type, Emergency Case (General Details
section of CF1)
+ Billing Address
- Member Basic Information:
+ Member Name, PIN, Gender, Date of Birth, Email, Mobile and Telephone
(Member Information section of CF1)
- Patient Basic Information
+ Patient Name, PIN, Gender, Date of Birth, Email, Mobile and Telephone (Patient
Information section of CF1)
- Employer Information
+ Pen and Employer Name (Employer Information section of CF1)
- Confinement Information
+ Referred?, Referral Facility Accreditation Code, Reason/s for referral/transfer,
Admission Date & Time, Discharge Date & Time, Expired Date & Time???,
Accommodation Type, Has Attached SOA? (Confinement Information section of
CF2)
- Diagnoses Information:
+ Admission Diagnosis, Discharge Diagnosis and ICD10 Code/s (Diagnosis section
of CF2)
- Case Rates
+ Case Rate Code, ICD10 Code, RVS Code, Amount (Case Rates section of CF2)
- Professional Fees / Charges Information
+ Doctor Name, Accreditation Number, With Co-pay, Co-pay Amount, Date
Signed (Professional Fees / Charges section of CF2)
- Certification of Consumption of Benefits Information
+ Enough Benefits, Total Health Care Institution Fees, Total Professional Fees and
Grand Total (Certification of Consumption of Benefits section of CF2)

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Id Test type Summary

1 Manual Claims tab

2 Manual Claims tab when not has any claim

3 Manual Claims tab when has any claim

4 Manual Claims tab

5 Manual Button More + at Claims tab

6 Manual For Filing Claims tab

7 Manual Refiled Claims tab

8 Manual Button Create New Claim

9 Manual 1. Eligibity tab

11 Manual 2. CF1 tab

Member Information section:

Member's Address Information

Patient Information section: section

Employer Information section:

17 Manual 3. CF2 tab

Confinement Information section of

19 Manual Diagnosis section of 3. CF2 tab

Button + Add RVS at Diagnosis

Button + Add discharge Diagnosis at

21 Manual Case Rates section of 3. CF2 tab

Special Considerations section of 3.

Button + Add at Special

For MCP (Enumerate four dates

For TB DOTS Package section of 3.

For Animal Bite Package (Write the

Newborn Care Details section of 3.

HIV/AIDS Treatment Details section

Cataract Treatment Details section

Professional Fees / Charges section

33 Manual Total Professional Fee section

35 Manual Access Patient Record section

"Patient" selection at Signed By of

"Representative" selection at Signed

"Thumbmark" selection at Signed

39 Manual 4. CF3 tab

Availed Maternity Care Package

Availed Maternity Care Package

42 Manual Consultation Information section

43 Manual Complaints Information section

44 Manual Maternity Details section

46 Manual Medical Surgery section

48 Manual Post Partrum Information section

49 Manual Post Partrum Information section

Button "Click Here To Add XLSOS" of

51 Manual 4. CF4 tab

PROFILING - Health Screening &

54 Manual Chief Complaint section

OB/GYN History (For female Patient

Pertinent Signs and Symptoms on

Physical Examination on Admission

PEPERT (Physical Examination

PEMISC (Physical Examination

Value of dropdown list Heent

Value of dropdown list Chest/Lungs

Value of dropdown list CVS/Heart

Value of dropdown list Abdomen

Value of dropdown list Abdomen

Value of dropdown list Skin /

68 Manual Course in the Ward section

Button + Add at Course in the Ward

MEDICINE ( List of Prescribed Drugs

Button + Add at MEDICINE ( List of

72 Manual 6. Requirements tab