Patients & Visitors / Medical Report Application

Medical Report Application

Secure connection to access your Medical Record

By securely connecting with our dedicated team, you can conveniently access your comprehensive health information.

Our utmost priority lies in upholding stringent standards to safeguard the accuracy of data, preserve patient privacy, and maintain strict confidentiality protocols.

Avisena Women’s & Children’s Specialist Hospital Medical Records Department (MRD) provides service for the request of:

Written Medical Report
Completion of Insurance claim form, PERKESO, KWSP, Vaccination Record etc.
Investigation report such as laboratory result or radiology report
Copy of Discharge Summary, Medical Certificate (MC) or Referral Letter.

Operation Hours

Day	Operation Hours
Monday – Friday	8:30am – 5:00pm
Saturday	9:00am – 1:00pm
Sunday & Public Holiday	Close

Location & Contact Details

Avisena Women’s & Children’s Specialist Hospital
Level 7
No.3, Jalan Perdagangan 14/4,
Seksyen 14, 40000 Shah Alam, Selangor.
03-55151888 (20711-ext)
medicalreportawcsh@avisena.com.my

Consent Form

Patients’ written consent is compulsory for the release of the medical information. For patients under 18 years of age, or has a mental incapacity to consent for the release of information, or is deceased, consent is required from the parents / guardian / next-of-kin / legal representative.

Download Consent Form

Frequently Asked Questions (FAQ)

How do I apply for Medical Report?

You may apply for your Medical Report using one of the following methods:

Applying at the Medical Record Department Counter:

Avisena Women’s & Children’s Specialist Hospital
Level 7
No.3, Jalan Perdagangan 14/4,
Seksyen 14, 40000 Shah Alam, Selangor.

Application via Online Form

To request an online application, please click the button below.

Request Here

What are the documents required?

The documents indicated below are necessary in order for us to process your request.

Patient:

Copy of NRIC or Passport
Related form (based on application)
Others document (related to the application/treatment)
Payment (based on the application)

Parents/Legal Guardian for patient under 18 years old:

Copy of Patient’s NRIC @ Patient’s Passport @ Patient’s Birth Certificate
Copy of NRIC @ of Parents / Legal Guardian’s Passport
Statutory Declaration (related)
Related document (based on application)
Others document (related to the application/treatment)
Payment (based on application)

Representative (Spouse, parents, legal guardian, next of kin):

Original consent letter from legal heirs
Copy of NRIC @ Passport legal heirs
Copy of Death Certificate (for deceased)
Related documents (based on application)
Others document (related to the application/ treatment)
Payment (based on type of report required)

Agents (Insurance/Lawyer etc):

Copy of NRIC @ Patient’s Passport @ Birth Certificate
Copy of NRIC @ Passport of parents/Legal Guardian (if patient is below 18 years old)
Copy of NRIC @ Passport of Agent
Original consent letter from patient/legal heirs
Copy of Death Certificate (for deceased patient)
Related document (based on application)
Other documents (related to the application/treatment)

The exemption of the consent letter and payment is applicable to agencies that have been authorized under the provisions of the law for the purpose of investigation.

How soon can I obtain my Medical Report?

Standard medical reports and insurance claims should be ready for collection 14 working days from the time all required documents and payment is received. In some circumstances, requests may take longer to complete than expected. The following factors can result in prompt processing delays:

Unavailability of doctors (e.g. away on leave)
Patients having upcoming clinic appointments
Patients remain hospitalised or admitted. Patients have multiple reports requested from several doctors
Doctor’s limited no. of clinic sessions hospital (e.g. only two sessions per week)
Visiting / Sessional doctors with limited clinic sessions
Incomplete document received

How much is the Medical Report fee?

The following table contains the pricing structure for completing medical reports, which is subject to change at any time. You will be informed if there are any additional fees associated with the report. Any additional fee will be collected upon report completion.

Request Type	Specialist	Medical Officer (MO)
Medical History	RM150	RM80
Medical Report (Written)	RM150	RM80
Medical Report for Lawyer (Written)	RM300	RM300
Insurance Form for Claim	RM80	RM50
KWSP/SOCSO	RM80	RM50
Immunization Record	RM50	RM50
Immunization Book	RM5	RM5
Photocopy of Medical Certificate	RM5	RM5
Medical Report for Police (requested by Police Officer only)	FOC	FOC
Copy of Lab Result/Radiology Report/others	FOC	FOC

Mail Charges	Fee
General Mail by GDEX – Local	RM10

What is the mode of Payment?

Payment can be made using any of the following:

1) CASH or Debit/Credit Card at Business Office counter

2) Online Transactions

Account Details:

Bank: MAYBANK
Account Name: Avisena Healthcare Sdn Bhd
Account Number: 562106694693

(please email the receipt to medicalreportawcsh@avisena.com.my)

How can I collect my Medical Report?

Once the report is ready, we will notify you either by phone or email. You have two option by receiving the report:

Option 1

You can collect it over the counter at Medical Record Department (MRD) during normal operations hours.

Option 2

Alternatively, we can send the report to you by courier (additional cost applies). The report will be couriered according to provided address in the Medical Report Application Form.