Get Hk New Territories West Cluster Medical Report And Patient Information Application Form 2017-2025

The HK New Territories West Cluster Medical Report and Patient Information Application Form is essential for requesting medical reports and patient information. This guide will provide you with clear, step-by-step instructions on filling out the form online to ensure that your application is submitted accurately and efficiently.

Follow the steps to successfully complete your application form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'To' section, select one suitable hospital by marking the appropriate box: Tuen Mun Hospital, Pok Oi Hospital, Castle Peak Hospital, Siu Lam Hospital, or Tin Shui Wai Hospital.
3. Complete the 'Patient's Particulars' section. Fill in the patient's name in English and Chinese, HKID or Passport number, date of birth, address, and daytime contact number. Ensure all fields are completed accurately.
4. In the 'Information Requested' section, check the nature of your request. Indicate whether it is a medical report or other documents, and specify the period of information requested along with any specialties required.
5. Specify the purpose of this application by marking the appropriate box. Options include continuity of care, insurance claims, public housing applications, legal proceedings, personal reference, immigration/visa applications, family reunion support, or others.
6. If you are completing this form as an applicant or agent, fill in 'Personal particulars of Applicant/Agent' with your name in English and Chinese, HKID or Passport number, contact number, corresponding address, and relationship with the patient.
7. Obtain the patient's signature if they are 18 years or older, consenting to disclose their information. If the patient is under 18 or deceased, fill out the relevant sections for their parents, next of kin, or legal representatives.
8. For the mode of release, select whether to receive the documents by mail or to collect them in person.
9. Review the form for accuracy. Save your changes, then proceed to download, print, or share the completed form as needed.

Begin the process of completing your application form online today.