Permohonan Laporan Perubatan
JENIS LAPORAN DAN BAYARAN
Sila rujuk dokumen di bawah yang diperlukan semasa mengemukakan permohonan laporan perubatan/ laporan bedah siasat
A. PESAKIT (sendiri) – PATIENT |
1. Salinan kad pengenalan/passport pesakit – Copy Identification/passport Patient 2. Salinan kad temujanji / discaj note / bil Hospital – Copy Appointment Card /Discharge Note / Hospital Bill 3. Borang berkaitan (Insurans/KWSP/PERKESO/Buruh ‘90 dll) – Related Form (Insurance/KWSP/PERKESO/’Buruh ’90 etc) 4. Bayaran - Payment |
B. IBU BAPA (pesakit berumur 18 tahun kebawah) – PARENT (Patient below 18 years) |
1. Salinan kad pengenalan / passport pesakit – Copy Identification/passport Patient 2. Salinan Sijil Lahir Pesakit – Copy of Patient Birth Certificate 3. Salinan kad pengenalan ibu/bapa/penjaga yang sah - Copy of valid parent Identity Card 4. Salinan kad temujanji / discaj note / bil Hospital Copy Appointment Card /Discharge Note / Hospital Bill 5. Borang berkaitan (Insurans/KWSP/PERKESO/Buruh ‘90 dll) Related Form (Insurance/KWSP/PERKESO/’Buruh ’90 etc) 6. Bayaran - Payment |
C. WAKIL PESAKIT / WARIS TERDEKAT ( Suami Isteri, Anak, Adik beradik kandung) – PATIENT REPRESENTATIVE / NEXT OF KIN (Husband Wife, Children, Biological Siblings) |
1. Surat keizinan ASAL dari pesakit (menyatakan nama agen atau wakil) Original Consent letter from patient (mention agent name or representative) 2. Salinan kad pengenalan/passport pesakit – Copy Identification/passport Patient 3. Salinan kad pengenalan/pasport pemohon - Copy Identification/passport Applicant 4. Salinan kad temujanji / discharge note / bil hospital pesakit Copy Appointment Card / Discharge Note / Hospital Bill 5. Borang berkaitan (Insurans/KWSP/PERKESO/Buruh ‘90 dll) Related Form (Insurance/KWSP/PERKESO/’Buruh ’90 etc) 6. Salinan kad pengenalan ibu/bapa/penjaga yang sah (Jika berkaitan) Copy of valid parent / guard Identity Car (If Applicable) 7. Salinan sijil nikah (jika berkaitan) – Copy of married Certificate (If Applicable) 8. Salinan sijil lahir (jika berkaitan) - Copy of Birth Certificate (If Applicable) 9. Perintah Makamah (jika berkaitan) – Court Order (if Applicable) 10. Salinan permit kubur / Sijil Kematian – Copy of graves permit / death certificate (If Applicable) 11. Bayaran – Payment |
Nota :
i) Borang KWSP, Insurans, PERKESO TIDAK disediakan. Sila dapatkan borang berkenaan di jabatan/agensi berkenaan. KWSP, Insurance , PERKESO form NOT provided. Kindly please get the form at the relevant department / agency
ii) Wakil yang hadir untuk mengambil laporan bagi pihak pemohon perlu mempunyai Surat Turun Kuasa. Representatives who are present to take a report on behalf of the applicant must have Authorized from Applicant