MEDICAL REPORT APPLICATION PROCEDURE
PATIENT INFORMATION DEPARTMENT SERVICES Management of patients' medical records, physically and electronically Issuance of patient information Medical report management Hospital statistics management Classification of diseases/clinical procedures based on the ICD standards HASA UiTM PUNCAK ALAM
TABLE OF CONTENTS Introduction Medical Report Types Application Process How to Apply Fee Categories Applicants and Required Documents Contact Us 10 HASA UiTM PUNCAK ALAM
MEDICAL REPORT Medical Report is a written form of information regarding the history, health status, and condition of a patient who has received treatment at the hospital. The preparation and issuance of a Medical Report are exclusive responsibilities entrusted to the Medical Officer within the Clinical Department where the patient received their treatment. The Medical Officer, being a qualified healthcare professional, possesses the necessary expertise to compile and convey accurate medical information. The report is written based on the information found in the patient's medical records. 1 HASA UiTM PUNCAK ALAM
MEDICAL REPORT TYPES 1) Test Results Report HASA UiTM PUNCAK ALAM 3) Specialist Medical Report 4) Insurance Claim 5) Purchasing an Insurance Policy 2) Brief Medical Report by Medical Officer 6) Detailed Specialist Report Expert opinion Post mortem report Blood Test Results, Radiology Test Results, Tests at the NICL, Tests at the Respiratory Lab, & others Application Form for OKU / Zakat / ‘Sihat Selangor’/ MySalam, & others. Insurance reimbursement/ ward admission claim PERKESO/EPF Expert report/medical board report. Court case (summary report). 7) Free Medical Report Police case (with official PDRM letter only) Official request from a government department/hospital 2
APPLICATION PROCESS Request by counter, email or mail. Payment and application complete. The completion period for the medical report is 28 working days. HASA UiTM PUNCAK ALAM DAY 1 DAY 2-3 DAY 4-25 DAY 26 DAY 27-28 Trace patient’s medical record. Identify the doctor and send the application. Medical report done by doctor and collected by Patient Information Department. Make a photocopy and proper filing in medical report drawer. Inform the applicant by phone call and SMS. Medical Report is ready to collect. 3
HOW TO APPLY AT COUNTER Patient/ agent/ representative walk in to request medical report HASA UiTM PUNCAK ALAM Bring NRIC photocopy, related documents (Insurance claim form/ Zakat form + quotation/PERKESO or EPF form etc) Fill in ‘Permohonan Laporan Perubatan’ and Consent for release of medical report forms Attach together with ‘Senarai Semak pergerakan laporan perubatan’ and ‘Permohonan bayaran bagi penyediaan laporan perubatan’ forms filled by PIC Patient make payment at billing counter 2nd floor, Anjung Zam-zam lobby. Leave the forms there, the person in charge of medical reports will retrieve it The process of completion medical report is 28 working days, and 7 working days for Test result report Completed medical reports are ready for collection once person in charge inform through a call and SMS Write down full name, NRIC and signature in medical report book upon collection 4
FORMS HASA UiTM PUNCAK ALAM ‘Permohonan Laporan Perubatan’ form Consent for Release of Medical Report form 5
HOW TO APPLY VIA EMAIL Email to [email protected] Please state: Patient’s full name and NRIC Purpose of applying medical report Photocopy of patient’s NRIC Related documents HASA UiTM PUNCAK ALAM Person in charge will reply with ‘Permohonan Laporan Perubatan’ and Consent for release of medical report forms How to make a payment Once payment is made, person in charge will proceed the medical report request. The process of completion medical report is 28 working days, and 7 working days for Test result report. 6
HOW TO APPLY VIA MAIL Send the medical report request letter to the address: Aras 5, Jabatan Maklumat Pesakit, Hospital UiTM Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Attach together; Photocopy of patient’s and/or applicant’s NRIC Related documents (claim form/zakat form/consent form) HASA UiTM PUNCAK ALAM Once payment is made, person in charge will proceed the medical report request. The process of completion medical report is 28 working days, and 7 working days for Test result report. 7
REPORT TYPES DESCRIPTION FEE Test Results Report Blood Test Results, Radiology Test Results, Tests at the NICL, Tests at the Respiratory Lab, & others RM40 Brief Medical Report by Medical Officer Application Form for OKU / Zakat / ‘Sihat Selangor’/ MySalam, & others Insurance reimbursement/ ward admission claim RM50 Specialist Medical Report PERKESO/EPF Expert report/medical board report. Court case (summary report). RM80 RM100 RM200 Insurance Claim Purchasing an Insurance Policy RM120 RM200 Detailed Specialist Report Expert opinion Post mortem report RM200 - RM1000 Police case (with official PDRM letter only) Official request from a government department/hospital FREE MEDICAL REPORT FEE HASA UiTM PUNCAK ALAM **Double charges are imposed on non-Malaysian patients. Post delivery charges for completed medical reports: Peninsular Malaysia - RM10 Sabah & Sarawak - RM20 8
REQUIRED DOCUMENTS PATIENT Copy of NRIC or Passport Related form (based on application) Others document (related to the application/ treatment) Self Agency/ Representative Original consent letter from legal heirs Copy of NRIC @ Passport legal heirs Copy of Death Certificate (for deceased) Related form (based on application) Others document (related to the application/ treatment) Representative from insurance agent/ lawyer Parents/ Legal guardian Copy of Patient’s NRIC @ Patient’s Passport @ Patient’s Birth Certificate Copy of NRIC @ of Parents / Legal Guardian’s Passport Statutory Declaration (if related) Related form (based on application) Others document (related to the application/treatment) Patient under 18 years old Heirs Copy of NRIC @ Patient’s Passport @ Birth Certificate Copy of NRIC @ Passport of parents/ Legal Guardian (if patient is below 18 years old) Copy of NRIC @ Passport of Agent Spouse, husband, parents, children, siblings 9 HASA UiTM PUNCAK ALAM Original consent letter from patient/ legal heirs Copy of Death Certificate (for deceased patient) Related form (based on application) Other documents (related to the application/treatment)
Operation Hour Medical Report Counter Monday to Thursday: 8.00 am - 1.00 pm 2.00 pm - 5.00 pm Lunch Hour : 1.00 pm - 2.00 pm Friday : 8.00 am - 12.15 pm 2.45 pm - 5.00 pm Saturday, Sunday & Public Holiday: CLOSED PHONE MAIL SITE ADDRESS Ms. Umi: 03-33963000 ext :14810 Mrs. Zara: 03-33963000 ext : 14802 [email protected] https://hospital.uitm.edu.my Level 5, Patient Information Department Hospital Al-Sultan Abdullah, Universiti Teknologi MARA, 42300 Bandar Puncak Alam, Selangor Contact Us 10 HASA UiTM PUNCAK ALAM