Medical Report

APPLICATION DOCUMENTS

( Please click here to download The Medical Report Application Form )

Please refer below for document requirements when submitting a medical report application

Patient (Self)

Application form HKL/JRP/ML-102 (Pind.1/2019)
A copy of the patient's identity card / passport
A copy of the patient's appointment card/ Discharge Note/ Hospital Bill
Fee (according to the type of application)
Related forms (Insurance/ KWSP/ PERKESO/ ‘Buruh’ 90 ect)
Other documents (related to application / treatment)

Mother / Father / Guardian (Patients under 18 years old)

Application form HKL/JRP/ML-102 (Pind.1/2019)
Original consent letter from the parent / legal guardian
A copy of the patient's birth certificate
A copy of the patient's identification card / the patient's passport
A copy of ID card / passport of valid mother / father / guardian
A copy of the patient's appointment card/ Discharge Note/ Hospital Bill
Affidavit (related)
Payment (according to the type of application)
Related forms (Insurance/ KWSP/ PERKESO/ ‘Buruh’ 90 ect)
Other documents (related to application / treatment)

Heirs (Husband / Wife / Children / Siblings / Mother / Father)

(For deceased patients)

Application form HKL/JRP/ML-102 (Pind.1/2019)
Original consent letter from the legal heir
Copy of birth certificate / identity card / passport of the deceased
Copy of birth certificate / identity card / passport of valid heir
Copy of death certificate / burial permit of the deceased
Copy of the deceased's appointment card/ Discharge Note/ Hospital Bill
A copy of the marriage certificate (if Applicable)
A Copy of birth certificate (if Applicable)
A valid heir declaration letter (if Applicable)
Payment (according to the type of application)
Related forms (Insurance/ KWSP/ PERKESO/ ‘Buruh’ 90 ect)
Other documents (related to application / treatment)

Representative / Agent ( Insurance / Lawyer / Others )

Application through writing or application form HKL/JRP/ML-102 (Pind.1/2019)
Original consent letter from the patient / legal next of kin
Original permission letter from the embassy of the patient / the deceased
Letter of consent of the representative to obtain a medical report
Other documents that refer to the following status :

Patient
Mother / Father / Guardian
Heir

Exceptions to Letter of Authorization and Payment

Applies to agencies that have been authorized under the provisions of the law for the purpose of investigation such as:

Royal Malaysian Police
Court
Any agency that has been authorized under the provisions of the law to obtain a patient's medical report.

Note :

i) Medical Check-up, all related to medical verification such as OKU, Welfare, Zakat, Medical Care Form (JPA) and sick leave certificate are not included in the medical report category.

ii) KWSP, Insurance, MySalam, PERKESO Form is NOT AVAILABLE. Please get the relevant form at the relevant department/ agency

iii) The representative present to take the medical report on behalf of the applicant must have a Power of Attorney.

TYPES OF REPORTS AND PAYMENTS

Report Type	Payment Charges		Prepared By
Report Type	Citizen	Foreigner	Prepared By
Regular Medical Report	RM 40.00	RM 80.00	Medical Officer
Specialist Summary	RM 80.00	RM 240.00	Specialist
Specialist Detail Report	RM 200.00 until RM 1,000.00	RM 400.00 until RM 2,000.00	Specialist
Clinical Post Mortem	RM 1,000.00	RM 2,000.00	Specialist
Xray Report	RM 80.00	RM 240.00	Specialist
Radiology Report	RM 200.00 Until RM1,000.00	RM 400.00 Until RM 2,000.00	Specialist
Report A Second Copy of The Original Report	50% from the original charge rate		Medical Officer/ Specialist
Re-Adjustment Report	Payment according to the original / full charge		Medical Officer/ Specialist
Clarification / Correction Report	Free		Medical Officer/ Specialist
Medical Report by Police / Government Department / JKM / Legal Aid Bureau / BAT Form F117 (Military)	Free		Medical Officer/ Specialist

** Payment exemption does not apply for insurance purposes and EPF withdrawals

At the Medical Legal Unit counter, all payments must be made by debit or credit card.

For payment by check or postal order payment, the recipient's name is PENGARAH HOSPITAL KUALA LUMPUR.

OPERATION HOURS

Day	Open	Close
Monday – Thursday	8.00 am – 1.00 pm 2.00 pm – 4.30 pm	1.00 pm – 2.00pm
Friday	8.00 am – 12.15 pm 2.45 pm – 4.30 pm	12.15 pm – 2.45 pm
Saturday, Sunday & Public Holiday	Close