Promissory Note for a Hospital Bill 2026: How It Works & What to Include

Quick Answer: Under RA 9439, if you can't pay your hospital bill you have the right to leave and get your medical certificate plus discharge papers by signing a promissory note for the unpaid balance. The note must be secured by either a mortgage or a co-maker jointly and severally liable with you. Ask the hospital's billing or Medical Social Service (MSS) office for their promissory note form. A ₱100 million DOH fund partly covers unpaid notes of indigent patients — exhaust Malasakit, PCSO, and DSWD AICS first so the note itself is as small as possible.

Table of Contents

• What is a hospital promissory note, and what law protects you?
• What are your two options for securing the note?
• What should the promissory note include?
• Can you demand your medical certificate and discharge papers once you sign?
• What is the ₱100 million DOH fund for unpaid notes?
• How do you actually get a promissory note, step by step?
• What happens if you can't pay the note later?
• Frequently Asked Questions
• Conclusion

What is a hospital promissory note, and what law protects you?

A hospital promissory note is a written promise to pay your unpaid balance later, which the law lets you sign in exchange for being allowed to leave the hospital right now. The legal basis is RA 9439, the Anti-Hospital Detention Law of 2007, implemented through DOH Administrative Order 2008-0001. The law bars hospitals and clinics from detaining a patient, or the body of a patient who has died, over an unpaid bill once that patient has recovered enough to leave. A promissory note is the mechanism the law gives you to exercise that right: instead of staying confined because you can't settle the account, you formalize the debt on paper and walk out. This is a right you can assert directly with the hospital's billing or MSS office; you don't need a court order to invoke it.

What are your two options for securing the note?

RA 9439 requires the promissory note to be backed by either a mortgage or a co-maker who is jointly and severally liable with you — the hospital cannot demand collateral outside these two options. A mortgage means pledging property (commonly land, a vehicle, or another asset) as collateral, which the hospital could move against if the debt goes unpaid. A co-maker is a second person who signs alongside you and takes on the full weight of the debt, not a fraction of it. "Jointly and severally liable" means the hospital can legally pursue the co-maker for the entire unpaid balance, not just half, and it can choose to go after either of you first — the co-maker isn't just a character reference, they're as legally exposed as you are. Anyone standing as a co-maker should understand that before agreeing.

What should the promissory note include?

A hospital promissory note typically states who owes the money, how much, when it's due, and what secures it. At minimum, expect it to cover: the parties (you as the patient/debtor, plus your mortgage collateral or co-maker); the amount owed (the outstanding balance after PhilHealth, discounts, and any assistance already applied); the payment terms (a due date or installment schedule the hospital agrees to); and the security (the mortgage details or the co-maker's signature and ID). Hospitals almost always have their own standard promissory note form issued through the billing office or Medical Social Service office — you fill in and sign theirs rather than drafting your own from scratch. Because the exact wording, required attachments, and internal approval process vary by hospital, ask the MSS or billing office for their specific form and confirm what IDs or documents they require from you and your co-maker before you sit down to sign.

Can you demand your medical certificate and discharge papers once you sign?

Yes. Once you've executed the promissory note, RA 9439 gives you the right to demand your medical certificate and discharge papers on the spot — the hospital cannot withhold these documents as additional leverage after you've already secured the unpaid balance with a mortgage or co-maker. This is the entire point of the law: the note replaces detention as the hospital's way of protecting itself financially, so once it's signed, there's no remaining legal basis for the hospital to keep you, your records, or your discharge paperwork. If a hospital staff member still refuses to release these documents after a properly executed note, that's a violation you can escalate (see below), not something you have to accept or negotiate further.

What is the ₱100 million DOH fund for unpaid notes?

RA 9439 also created a ₱100,000,000 fund managed by the DOH specifically to partly cover promissory notes that poor and indigent patients are unable to pay. This matters because it changes the practical risk of signing: the note isn't purely a personal debt hanging entirely on you or your co-maker forever — for patients who qualify as poor or indigent, the fund is meant to absorb part of the shortfall on the hospital's end. DOH has not published detailed eligibility criteria, an application process, or a per-patient cap for drawing on this fund, so confirm current details directly with the hospital's MSS office or DOH when you're arranging your note. Getting properly classified as indigent through the MSS office (see our patient classification guide) is worth doing before you sign, since that classification is likely what determines whether this fund applies to your case.

How do you actually get a promissory note, step by step?

Work through these steps in order — a promissory note should be your last move, not your first, since every peso you secure elsewhere is a peso you don't have to put your name (or a co-maker's) behind.

1. Exhaust assistance first. Before asking about a promissory note, work through the Malasakit Center, PCSO medical assistance, and DSWD AICS to shrink the balance as much as possible. Confirm PhilHealth was applied and check whether you qualify for Zero Balance Billing or a charity ward bed.
2. Ask the billing or MSS office for their promissory note process. Every hospital has its own form and internal steps — request theirs rather than trying to draft your own.
3. Decide on your security. Confirm with the office whether you're offering a mortgage or bringing a co-maker, and what documentation each requires.
4. Negotiate the terms. Ask about the payment schedule and due date before signing; these are typically discussed directly with the billing office.
5. Sign, and demand your documents. Once the note is executed, ask for your medical certificate and discharge papers immediately.
6. Escalate if refused. If a hospital resists letting you sign a note and leave, or withholds documents after a valid note, you can raise it with the DOH, file a habeas corpus petition in court, or seek help from the Public Attorney's Office (PAO), which assists indigent patients.

What happens if you can't pay the note later?

If you default on a hospital promissory note, the hospital's remedy is collection, not detention — RA 9439 does not permit a hospital to re-detain you or otherwise punish you physically for failing to pay a note you already signed and left on. The note becomes an ordinary debt obligation, pursued the same way any creditor pursues an unpaid mortgage or a co-maker's liability, through collection efforts or civil action, not by holding you at the hospital. It's the hospital that faces legal exposure for detaining a patient over nonpayment: current penalties under RA 9439 are a ₱20,000-50,000 fine, 1-6 months imprisonment, or both. A pending Senate bill, SB 2724, would raise those penalties substantially — up to ₱200,000 or 3 years for hospital officers and employees, and up to ₱2,000,000 or 6 years for directors or managers found to have institutionalized detention practices, with the Commission on Human Rights backing the measure in February 2026. As of this writing, SB 2724 is not yet law — the ₱20,000-50,000 / 1-6 months penalty is what currently applies.

Frequently Asked Questions

Is a hospital promissory note the same as a normal loan?

Not quite. It's a debt instrument specific to hospital bills, created under RA 9439 so you can legally leave the hospital when you can't pay in full. Like a loan, it must be secured — by a mortgage or a co-maker jointly and severally liable — and becomes an ordinary collectible debt if unpaid, but its main purpose is securing your immediate release and discharge paperwork, not financing a purchase.

Can the hospital refuse to let me sign a promissory note?

No. RA 9439 gives you the right to leave by executing a promissory note when you're unable to pay in full. If a hospital refuses to offer this option or continues to detain you after you've offered acceptable security, you can escalate to the DOH, file a habeas corpus petition, or seek help from PAO.

What's the difference between a mortgage and a co-maker as security?

A mortgage pledges specific property as collateral; a co-maker is a person who signs the note and becomes jointly and severally liable for the full balance alongside you. With a co-maker, the hospital can pursue that person for the entire amount, not a partial share — it's a serious commitment, not a formality, so make sure whoever agrees to be your co-maker understands that.

Does the hospital have a standard promissory note form I should use?

Yes, generally. Hospitals typically have their own promissory note form managed through the billing or Medical Social Service office. Ask that office for their form and process rather than writing your own; the exact required fields and attachments vary by hospital.

Do I need to pay the full balance immediately after signing?

The note itself sets the payment terms — typically a due date or schedule you negotiate with the billing office when you sign. The point of the note is that you don't have to pay before leaving; you're committing to pay according to the terms in the note instead.

What if I still can't pay after the due date on my note?

The hospital's remedy is collection, not re-detention — RA 9439 doesn't allow a hospital to hold you again over a note you've already defaulted on. It becomes a standard debt collection matter, pursued through the mortgage or against the co-maker, the same way any unpaid obligation would be.

Is there help if I truly can't afford any promissory note terms?

Before signing anything, make sure you've gone through the Malasakit Center, PCSO, and DSWD AICS options to shrink the balance. RA 9439 also created a ₱100 million DOH-managed fund that partly covers unpaid notes for poor and indigent patients — ask the MSS office whether your case qualifies.

Can I get in legal trouble for signing a promissory note I can't fully pay?

No — signing the note itself is not a crime, and defaulting on it turns it into a civil debt matter handled through collection, not criminal detention or punishment. The criminal penalties under RA 9439 apply to the hospital if it detains a patient over an unpaid bill, not to the patient for being unable to pay.

Conclusion

A promissory note is your legal fallback, not your first move, when a hospital bill is more than you can pay. Work through PhilHealth, Zero Balance Billing, and the Malasakit Center's stacked aid first, get properly classified by the MSS office, and only turn to a mortgage- or co-maker-secured note for whatever balance remains. If a hospital tries to hold you or your documents despite a valid note, know that RA 9439 protects you — see our full guide on hospital detention over unpaid bills for how to escalate. For the complete order of operations from admission to discharge, start with our can't pay your hospital bill guide, or search ClinicFinderPH to find accredited hospitals and check their billing practices before you're admitted.