If you are the patient – please complete Forms A and C.
If you are applying for a patient who has deceased or is mentally incompetent – please complete Forms A, B and C.
Form A – Application & Consent Form [pdf, 350kb]
Form B - Letter of Undertaking [pdf, 254kb]
Form C – Credit Card Authorisation Form [pdf, 222kb]
Please ensure all fields are completed and filled out correctly to avoid delays in processing.
We can only process your application upon fulfilling the verification and receipt of all necessary forms, supporting documents* and payment.
Scan and submit the forms and supporting documents* to
Mail your forms and supporting documents* to:
Drop your forms and supporting documents* into the Dropbox at our Medical Report Self-Help Booth.
SGH Block 3 Level 1
*Photocopies of patient's NRIC and all relevant documents (refer to Form A - e.g. insurance claim form, birth/marriage/death certificates etc).
TYPE OF MEDICAL REPORT
Completion of Simple Insurance Form (By HIMS)
Ordinary Medical Report
Provides the relevant facts about the medical condition and treatment/medication the patient is receiving. Report is in the form of a written report.
Completion of Insurance Form
Report is in the form of a medical insurance form questionnaire. Information required may consist of diagnosis, name of procedure, and details of medical condition or treatment given.
Ordinary Medical Report / Completion of Insurance Form (Psychiatric)
As above. For completion by the Department of Psychiatry only.
Completion of Workman Compensation Form
This is for the purpose of determining work-related injuries and the degree and period of disability. The doctor will fill up the MOM form "Medical Report on Traumatic Injuries for Workman’s Compensation" and this may involve a review of the patient at the Specialist Outpatient Clinic.
Specialist Medical Report / Percentage Disability Report
A Specialist Medical Report is a medical report in response to requests that requires the doctor's specific opinion and prognosis of your medical condition. This may require an assessment and a review of the patient at the Specialist Outpatient Clinic and specialist consultation will be borne by the patient separately. This is in addition to further tests such as radiological images or laboratory investigation procedures that are required for the completion of the Specialist Medical Report.
Specialist Medical Report / Percentage Disability Report (Psychiatric)
Admin Fee for Duplication of Medical Certificate
A certified true copy of the Medical Certificate issued by the wards and clinics.
Admin Fee for Duplication of Referral Letter
A certified true copy of Referral Letter from polyclinics or private medical centre.
Admin Fee for Duplication of Day Surgery Report / Hospital Inpatient Discharge Summary
A duplicate copy of the Day Surgery / Hospital Inpatient Discharge Summary. It will provide brief information of the surgery, diagnosis and procedure.
Admin Fee for Duplication of Investigation Results
Selective duplicate copies of investigation results such as blood test results, investigation reports (ECG, Electrophysiology, EMGS), X-ray and other radiological reports can be made available.
Admin Fee for Memo
Provides basic information as specified by the patient.
Duplication of Radiological Images in CD Format (General Procedure) (for subsidised patients)
X-ray films stored in CD format. For general procedures such as X-Rays of chest, abdomen, limbs etc
Duplication of Radiological Images in CD Format (Specialised Procedure) (for subsidised patients)
X-ray films stored in CD format. For specialised procedures such as CT, MRI, Ultrasound, Fluoroscopy, Vascular & Interventional, & Breast Imaging.
Please allow 4 - 6 weeks for processing of requests. Delays in prompt processing may be the result of: