Patient Information

Forms

Title Click to download
Sara Ubat
  1. Pekeliling Sara Ubat
  2. Borang Sara Ubat
Authorization Form
  1. Borang Keizinan Permohonan Laporan Perubatan / Surat Perakuan Perubatan (BK-MIS-034-E05)
  2. Borang Permohonan Pengesahan Laporan Perubatan (BK-MIS-791-E02)
  3. Borang Pengesahan Bujang / Waris (BK-MIS1163-E01)
  4. Borang Keizinan Mengumpul dan Memproses Data Peribadi (BK-MIS-1424-E01)
  5. Borang Menarik Balik Kebenaran Memproses Data Peribadi (BK-MIS-1425-E01)

 

Type of Application Payment Rate
(RM)
GST Rate 6%
(RM)
Total Amount
(RM)
Medical Report 80.00 4.80 84.80
Post-mortem Report 80.00 4.80 84.80
Insurance Form (exclude ward admission claim) 80.00 4.80 84.80
Insurance Form (claim of ward admission) 40.00 2.40 42.40
Health Statement Form 80.00 4.80 84.80
Copy of Medical Certification (MC) 5.00 0.30 5.30
Expert Medical Report 200.00 to 1000.00 12.00 to 60.00 212.00 to 1060.00
Expert Post-mortem Report 200.00 to 1000.00 12.00 to 60.00 212.00 to 1060.00

 

ADDRESS

  • Pusat Perubatan Universiti Malaya,
    Lembah Pantai, 59100,
    Kuala Lumpur, MALAYSIA

EMAIL

  • Email : ummc@ummc.edu.my

TEL

  • Phone No : 03-79494422
    Fax : 03-79492030

WEBSITE

  • WEBSITE : www.ummc.edu.my