Gleneagles Hospital Penang provides services for the request of completion of Insurance Forms, Medical Reports, Employees Provident Fund (EPF), Social Security Organization (SOSCO), and etc.
To ensure patient privacy and confidentiality, a consent or authorization letter from the patient is required for the application of the abovementioned. Alternatively, you may download and complete the Application Form for Release of Medical Information below.
Download Application Form for Release of Medical Information
Kindly be informed that all types of requests will be processed only upon the receipt of the consent / authorization and full payment.
FAQs
1. Who Can Request?
- Patients who are healthy/mentally fit, and 18 years old and above.
- For patients under 18 years old, or those with a mental incapacity to provide consent, a photocopy of identification documents or legal documents as a proof of relationship and consent are required from the parent or legal representative.
- If the patient is deceased, a photocopy of death certificate, marriage certificate, Letter of Administration as a proof of relationship to the deceased or a grant of probate and consent are required from the legal representative. A nominee letter from the insurance company is required for claim processing.
2. How Do I Apply For Medical Report?
- Application for Medical Report can be done by walk-in, via email, or mailing.
- Kindly refer to the table below on how to contact the Medical Report Office:
| Contact No.: | +604-222 9111 |
| Email: | my.gpg.claims@gleneagles.com.my |
| Address: | Medical Report Office, Gleneagles Hospital Penang, @First Floor, 1, Jalan Pangkor, 10050 GeorgeTown, Pulau Pinang. |
| Business Hours: | Monday-Friday: 8.30am to 4.30pm Saturday: 8.30am to 1.00pm Sunday & Public Holiday: Closed |
3. What Are The Documents Required For The Application?
- Patient's Consent / Authorization or completed Application Form for Release of Medical Information.
- If you are applying for completion of Insurance Form, Questionnaire, Endorsement, PERKESO or other related forms, please ensure all relevant information in the form are completed based on your request. (i.e patient's name, IC number, date of admission / visit, and etc.)
- A signature from a witness who is mentally fit and is 18 years old and above.
- Where applicable: Formal Application Letter such as Medical Report Form or Claim Form from the Insurance Company, EPF form, Perkeso form, etc.
4. When Can I Obtain My Completed Medical Report?
- A standard Medical Report should be ready for collection within 14 working days from the time where all required documents and payment are received. There are cases where your request may take longer than the stipulated completion
period. Delays in prompt processing may be due to:
- The doctor is away on leave
- Patient has upcoming clinic appointments
- Patient is still admitted or hospitalized
- Patient has multiple reports requested from several doctors
- Doctor’s limited number of sessions at Gleneagles Hospital Penang (e.g. one session per week)
- Requests for investigation reports will be completed in 3 to 5 working days from the time where the complete application form is received.
5. How Will I Receive The Completed Medical Report?
- Upon the completion of the report, we will inform the applicant via SMS, and depending on your preferred mode of collection, you may:
- Collect the report from the counters at Medical Report Office:
- ID verification (NRIC or Passport) is required before collection
- If collection is on behalf of the patient, an authorization letter signed by the patient is required
- Receive the report via mail:
- Report will be couriered to the mailing address provided in the Application Form
- Charges may be applicable for mailing services
- Receive the report via email:
- Report will be sent to the email address provided in the Application Form
- The documents will be encrypted with a password for security purposes
6. How Much Is The Medical Report Fee?
- The fee schedule for all types of Medical Reports is stated as per the table below. Kindly note, that the fee schedule is subject to change from time to time. Additional charges may be imposed on the report and you will be notified accordingly.
| Request Type(s) | Categories | Report(s) Fee (RM) |
| General Medical Reports | Attending Physician Statement, Personal Medical Attendant Report, Medical Attendant Report, Critical Illness Report, Death Claim, Medical Questionnaire, Hypertension Report, Gynaecology Report, O&G Report, Total Permanent Disability Report, Dread Disease Report, Permanent Partial Dismemberment Report, Confidential Medical Certificate, Congenital Condition Claim, and etc. | RM110 |
| Personal Medical Report | RM160 | |
| Employees Provident Fund (EPF) Report | EPF / EPFPD / EPFPD Pengesahan Perubatan (KWSP 9A) | Free of charge |
| Perkeso / SOCSO Reports | RM40 | |
| Claim Form | Personal Accident Claim | RM60 |
| Inpatient / Day Care | Subjected to Consultant | |
| Lawyer Firm Medical Reports | Medical Accident Report, etc. | RM260 |
| Specialist Report / Examination Report | Subjected to Consultant | |
| Investigation Reports | X-ray, Laboratory, Angiogram, ECG, NCS Hotter Report, etc. | Free of charge |
| Discharge Summary | Free of charge | |
| Doctor Memo | Subjected to Consultant | |
| Additional Insurance Deferment | RM50 |
7. How Can I Make My Payment?
- The payment can be made via cash, credit card, cheque, and bank transfer.
- You may refer to the Hospital’s account detail as per the table below for payment via bank transfer and cheque, which shall be payable to the bank name below.
| Beneficiary Name: | PULAU PINANG CLINIC SDN BHD |
| Account No.: | 80-0431249-9 |
| Bank Name: | CIMB BANK BERHAD |
| Bank Swift Code: | CIBBMYKL |
| Company Registration No.: | 10387K |
| Bank Address: | Menara BHL No 51, Jalan Sultan Ahmad Shah, 10050 Pulau Pinang. |
- For personal cheque, please note that the report and receipt will be released only upon the clearance of cheque.
- A gentle reminder that all outstanding amounts in the Hospital shall be settled together with the medical report fee to avoid any delay in processing.
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