1 |
Insurance Form (Simple)
This is normally requested by insurance companies for the purpose of medical insurance claims and contains the following information:
- Diagnosis,
- Source of referral (if known),
- Date of first consultation for the condition,
- Type of surgery/procedure/investigation performed (if applicable)
- Date of surgery performed (if applicable).
Please submit the physical insurance form for processing
| $22.35
|
2 |
Insurance Form (Complex)
This is normally requested by insurance company for the purpose of making medical insurance claims and contain the following information:
- Diagnoses,
- Source of referral (if known),
- Date of first consultation for the condition,
- Details of diseases/injuries suffered
- Treatment rendered
| $100.83
|
3 |
Ordinary Medical Report
This is a report prepared by a doctor, nurse or allied health professional and contains factual description of an encounter with a patient. It includes the following information:
- Summary of the patient’s history of complaint
- Findings and observations at the time of examination
- Treatment rendered
| $100.83
|
4 |
Specialist Medical Report
This is a report prepared by a doctor or allied health professional and includes information found in an ordinary medical report and the following additional information:
- Opinion/prognosis based on the medical facts of the case
- Specialist certification on functional or mental impairment including degree of disability
| $201.65
|
5 |
Second Opinion Report (For non-WH patient only)
This is a report requested by non-WH patient seeking second opinion from WH specialist. An appointment will be arranged for consultant to assess the patient. Patients may be required to provide the attending specialist their previous medical report or investigation results.
(Not to be used for Court purposes) | $335.72
|
6 |
Workmen Compensation Form
This is an assessment form issued by MOM for the purpose of determine work-related injuries and the degree and period of disability resulted from the work injury.
An appointment may be arranged for the patient to be assessed by the doctor, if necessary. The form will be sent to MOM directly.
| $100.83
|
7
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Workmen Compensation Objection Report
This is an assessment form issued by MOM for the purpose of re-determining work-related injuries and the degree and period of disability when the patient or patient’s employer or insurance provider disagrees with the results of the work injury compensation assessment report (initial) and raise an objection with MOM. The work injury compensation objection report is done by two senior consultants of the same discipline. Appointment may be arranged for the patient to be assessed by the doctor.
| $388.59
|
8 |
Lasting Power of Attorney (LPA) Report
This is a legal document that allows a person who is 21 years of age or older (donor), and who has mental capacity, to voluntarily appoint one or more persons (donee(s)), to make decisions and act on his behalf about his personal welfare, property & affairs matters or both matters when he lacks mental capacity to make those decisions in the future.
| $232.72
|
9 |
Psychiatric Medical Report (Complex)
This is a report prepared by the assigned psychiatrist in response to requests that require detailed professional opinion, with regards to patient’s assessment or condition, which may extend to domains of prognosis and disability. It is based on an actual assessment of the patient and may involve a review at the psychological medicine specialist outpatient. | $504.13
|
10 |
Functional Assessment Report
This is a report assesses a person need for assistance with the Activities of Daily Living (“ADLs”) and is only for the purpose of application for specific government schemes administered by
- The Agency for Integrated Care (the Pioneer Generation Disability Assistance Scheme, Home Caregiving Grant and Foreign Domestic Worker Levy Concession for Persons with Disabilities)
- SG Enable (Public Transport Concession for Persons with Disabilities)
- The Special Needs Trust Company (Special Needs Savings Scheme)
- The Housing & Development Board (Enhancement for Active Seniors) (collectively, “Long-Term Care Schemes”)
| $44.15
|
11 |
Duplication of Inpatient Discharge Summary / Day Surgery Report / Investigation Results (per copy) | $6.54
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12 |
Duplication of Medical Certificate (Certified True Copy) | $6.54
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