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For Patients ＆ Visitors

Request for Medical Report

What You Need To Provide

Patient's written consent for release of medical information to allow the hospital to release information for a stated purpose.

For patients below 21 years of age, consent of the parent is required.
If the patient is deceased, a copy of patient's death certificate and other supporting documents, e.g. marriage certificate, letters of administration are required as proof of the representative's relationship to the patient.

A copy of the patient's NRIC / identification documents
A payment for the medical information required.

How To Request For Medical Information

Download and complete the consent form.
If patient is deceased, please submit the additional consent form (C).
If patient is mentally incapacitated, please submit the additional declaration form (D).
For submission of Insurance or MOM forms to be completed by physician, patient is to duly complete relevant portions.
Interested third parties can write in together with patient's consent, permitting the hospital to release medical information for a stated purpose. Please submit the authorisation form, together with the consent form.
Foreign workers whom have returned to their native country, employers are required to submit indemnity form for Workmen Compensation and cancellation of work permit.
Walk-in request by patients, NOK and insurance agencies can be processed via the following service points;

Urgent Care Centre
Medical Records and Health Information (Block 10, Level 1)
Specialist Outpatient Clinics

Note: Request for medical report will only be processed upon receipt of ID documents, signed consent form, required insurance form and appropriate payment.

Products and Services Available

Products and Services Available

Price

Detailed Insurance Form:

Info required: Diagnosis, Details of injuries suffered, Treatment given.

$80.25

Ordinary Medical Report:

Report based on patient's medical records.
Info required: Medical problem.

$80.25

Completion of Forms:

Simple insurance form requested by insurance company of a Group Department.
Info required: Diagnosis, Diagnosis code, Procedure, Procedure code, Referring doctor.

$21.40

Investigation Results:

Photocopy of investigation results such as X-ray reports, CT scan reports, blood test results, ECG reports, Histopathology reports, Cytogenetic reports, Bone Density Report and Urine Test Result.

$10.70

Duplication of MC:

Application for a certified true copy of medical certificate for hospitalization / outpatient medical leave.

$10.70

Therapy Report:

By Physiotherapist / Occupational Therapist / Speech therapist / Podiatrist.
Info required: Diagnosis, Treatment Prescribed & Performance of the patient based on last therapy visit.

$80.25

Workmen Compensation:

Assessment to determine work-related injuries, the degree and period of disability for workmen's compensation purpose under the Workmen's Compensation Act. Scope of the report is as per "Medical Report on Traumatic Injuries for Workmen's Compensation" form prescribed by the Ministry of Manpower.
Note: The "Medical Report on Traumatic Injuries for Workmen's Compensation" form needs to be obtained from Ministry of Manpower. This may involve a review of the patient at the Clinic.

$80.25

Disability Claim Form:

Detailed insurance claim form provided by the insurance company.
To assess the patient's disability status.

$180.20

Specialist Medical Report:

Detailed medical report that usually highlights the history of medical complaint or injury.
Include findings of the assessment as well as their opinion and prognosis of the patient.
An appointment would be arranged if the doctor request for it.

$180.20

Second Opinion Report:

Requested by non-AH patient seeking second opinion from AH specialist.
An appointment will be arranged for to assess the patient.
Patients may be required to provide the attending specialist with their previous medical report or investigation results.

$267.50

Specialist Psychiatrist Report: