Get Chas Referral Form

Filling out the Chas Referral Form online is a straightforward process that facilitates referrals to subsidised specialist outpatient clinics. This guide will walk you through each section of the form, ensuring you have a clear understanding of the necessary information to provide.

Follow the steps to successfully complete the Chas Referral Form online.

1. Click the ‘Get Form’ button to access the Chas Referral Form and open it in the online editor.
2. In Part I, fill in the SOC appointment details including the department referred to, the appointment date and time, and the appointment location. Note that contact details are optional.
3. Move to Part II and enter the patient’s particulars. This includes the full name, gender, NRIC number, and contact number. Select the corresponding CHAS card type from the options provided: CHAS Blue, CHAS Orange, Pioneer Generation, or Public Assistance. Ensure to circle the gender accordingly.
4. In Part III, provide any relevant details from the doctor’s or dentist’s referral, including the patient’s medical history, presenting symptoms or diagnosis, and management plan. Attach additional documents or investigation results if necessary.
5. Complete Part IV by acknowledging that the practitioner is from a CHAS clinic, that the patient is a CHAS/PG/PA cardholder, and that they understand the conditions of the subsidised referral. Add the name and signature of the practitioner, along with their MCR or DCR number, date, clinic name, address, contact number, and email.
6. Once all sections are completed, review the information for accuracy. You can save your changes, download the completed form, print it, or share it as needed.

Complete the Chas Referral Form online today to facilitate your healthcare journey.