Get Medical Report And Patient Information Application Form - Www3 Ha Org

Completing the Medical Report And Patient Information Application Form can be straightforward if you follow the steps outlined in this guide. This form is critical for obtaining medical reports and patient information from hospitals.

Follow the steps to successfully complete the application form.

1. Click the ‘Get Form’ button to access the form and open it for editing.
2. Fill in your personal particulars in Part A. This includes your name in English and Chinese, your sex (select 'M' or 'F'), and your HKID or passport number along with your date of birth. Provide a daytime telephone number and your correspondence address.
3. Indicate the number of reports or certificates required and select the appropriate charges. Note that charges vary depending on the requested services.
4. In Part B, detail the information requested by checking the suitable boxes for nature of the request. You may need to attach documents such as proof of identity along with your request.
5. State the purpose of your application in B2, such as future medical purposes, insurance claims, or legal proceedings.
6. If the patient is under 18 years old, complete Part C with the particulars of the parent, legal guardian, or authorized agent.
7. Section D requires the signature of the parent, legal guardian, or authorized agent to give consent for the hospital to disclose information.
8. If applicable, fill in Part E with the personal particulars of the authorized agent and ensure their signature is included.
9. Part F requires the signature of the patient if they are 18 years or older to consent to the process.
10. In Part G, specify the intended dispatch of reports. Choose whether to receive the report at the patient’s address, the authorized agent’s address, or to collect it in person.
11. Once all sections are completed, review the form for accuracy. Save any changes, and if necessary, download or print the completed form for submission.

Take action now and complete your Medical Report And Patient Information Application Form online.