MEDICAL INFORMATION Brief Notes (Refer to the attached Notes on Application for the Release of Medical Information for full details.): 1. This form must be fully completed and signed by the patient or other relevant requestor. 2. Scanned copies / photocopies of patient s NRIC and all relevant documents (e.g. Birth Certificate, Marriage Certificate, Grant of Probate, Lasting Power of Attorney) as proof of the applicant s relationship to patient are required (Please refer to Note 6 for furthe.
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How to fill out the SG General Hospital HIMS-REP online
The SG General Hospital HIMS-REP form is essential for requesting the release of medical information. This guide provides clear and detailed instructions to assist you in completing this form accurately and efficiently.
Follow the steps to fill out the SG General Hospital HIMS-REP form online
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Provide the patient's particulars by filling in their name, NRIC or HRN, address, email address, and contact number. Ensure all details are accurate.
- In the authorization section, enter your name and NRIC number. Confirm your authorization for Singapore General Hospital to release the requested medical information.
- Specify the recipient of the medical information. Indicate whether it is for yourself or for an authorized representative and provide their name, address, email, and contact number.
- Select the type of request by ticking the appropriate box for the medical report format you require. Check the fee associated with each option.
- Mention the purpose of your request by selecting the relevant options, such as ‘Insurance Claims’ or ‘Legal Proceedings,’ and provide additional details if needed.
- Carefully read and complete the declaration statement affirming the accuracy of the information provided. Ensure that you understand the liability associated with your declaration.
- Sign and date the form as both the patient and the applicant if applicable. Include the relationship to the patient if you are not the patient.
- Once you have filled out all necessary fields and sections, save the changes, and proceed to download, print, or share the completed form as needed.
Complete your SG General Hospital HIMS-REP form online today for efficient processing of your medical information requests.
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