If you are the patient – please complete Forms A and C.
If you are applying for a patient who has deceased or is mentally incompetent – please complete Forms A, B and C.
Form A – Application & Consent Form [pdf]
Form B - Letter of Undertaking [pdf]
Form C – Credit Card Authorisation Form [pdf]
Please ensure all fields are completed and filled out correctly to avoid delays in processing.
We can only process your application upon fulfilling the verification and receipt of all necessary forms, supporting documents* and payment.
Scan and submit the forms and supporting documents* to [email protected]
Mail your forms and supporting documents* to:
Drop your forms and supporting documents* into the Dropbox at our Medical Report Self-Help Booth.
SGH Block 3 Level 1
*Photocopies of patient's NRIC and all relevant documents (refer to Form A - e.g. insurance claim form, birth/marriage/death certificates etc).
TYPE OF MEDICAL REPORT
DESCRIPTION
FEES(GST INCLUSIVE)
Ordinary Medical Report
Provides the relevant facts about the medical condition and treatment/medication the patient is receiving. Report is in the form of a comprehensive written report.
This is the report of choice for most request purpose.
$121.00
Completion of Insurance Form
Report is in the form of a medical insurance form questionnaire. Information required may consist of diagnosis, name of procedure, and details of medical condition or treatment given.
Necessary forms for completion needs to be furnished by the requestor.
Ordinary Medical Report /Completion of Insurance Form (Psychiatric)
As above. For completion by the Department of Psychiatry only.
$260.00
Completion of Workman Compensation Form
This is for the purpose of determining work-related injuries and the degree and period of disability. The doctor will fill up the MOM form "Medical Report on Traumatic Injuries for Workman’s Compensation" and this may involve a review of the patient at the Specialist Outpatient Clinic.
Completion of Workman Compensation Objection Form
As above. For the objection of the finalised Workman Compensation Report.
$370.00
Specialist Medical Report /Percentage Disability Report
A Specialist Medical Report is a medical report in response to requests that requires the doctor's specific opinion and prognosis of the patient's medical condition. This may require an assessment and a review of the patient at the Specialist Outpatient Clinic and specialist consultation will be borne by the patient separately. This is in addition to further tests such as radiological images or laboratory investigation procedures that are required for the completion of the Specialist Medical Report.
$222.00
Specialist Medical Report /Percentage Disability Report (Psychiatric)
$480.00
Deputyship Medical Report(MCA Form 224) / Activation of LPA
For the purpose of appointing a deputy or activating an LPA to make decisions for a person who lacks mental capacity.
Similar to a Specialist Medical Report, this requires the doctor's specific opinion and prognosis of the patient's medical condition. This may require an assessment and a review of the patient at the Specialist Outpatient Clinic and specialist consultation will be borne by the patient separately. This is in addition to further tests such as radiological images or laboratory investigation procedures that are required for the completion of the report.
Necessary forms for completion needs to be furnished by the requestor (e.g. MCA Form 224 or LPA Activation Form)
$222.00
Deputyship Medical Report (MCA Form 224) / Activation of LPA(Psychiatric)
As above. For completion by the Department of Psychiatry only.
$480.00
Duplication of Medical Certificate
A certified true copy of the Medical Certificate issued by the wards and clinics.
$12.00
Duplication of Referral Letter
A certified true copy of Referral Letter from polyclinics or private medical centre.
Discharge Summary(Inpatient / Day Surgery / A&E)
A discharge summary for the Inpatient Admission / Day Surgery / A&E visit. It will provide brief information of the surgery, diagnosis and procedure.
Investigation / Lab / Radiological Scan Results
Selective copies of investigation results such as blood test results, investigation reports (ECG, Electrophysiology, EMGS), X-ray and other radiological reports can be made available.
Admin Fee for Memo
Provides basic information as specified by the patient.
Duplication of Radiological Images in Thumbdrive Format (General) (for subsidised patients)
X-ray films stored in Thumbdrive format. For general procedures such as X-Rays of chest, abdomen, limbs etc
$54.84
Duplication of Radiological Images in Thumbdrive Format (Specialised)(for subsidised patients)
X-ray films stored in Thumbdrive format. For specialised procedures such as CT, MRI, Ultrasound, Fluoroscopy, Vascular & Interventional, & Breast Imaging.
$78.82
Please allow 4 - 6 weeks for processing of requests. Delays in prompt processing may be the result of:
