如何申请医疗报告书If.docVIP

Application for Medical Report 如 何 申 請 醫 療 報 告 書 If you want to apply for a medical report, please apply early, as the doctor will require time to prepare it. 醫療報告書由醫生撰寫, 辦理需時, 請盡早申請, 以免延誤。 All medical reports are written in English. This hospital does not provide translation service. The format of medical report is decided by the doctor. Attached forms may not be applicable. 醫療報告書以英文簽發, 本院並無翻譯服務。 報告書的形式由負責撰寫醫生決定, 附來表格未必適合填寫。 Application forms can be obtained from Medical Information Registry Office at Room 12, 1/F, Block E, QEH at 30 Gascoigne Road, Kowloon. The duly completed application form can be returned by mail. Please state “Application for Medical Report” on the envelope. 申請表格可在醫療資料申請辦事處(伊利沙伯醫院 E 座一樓十二號室)索取。 填妥後, 可親自交回或郵寄九龍加士居道三十號伊利沙伯醫院收, 信封面註明「申請醫療報告書」。 The application form may be a photocopy. 申請表格可影印多份使用。 For easy retrieval of relevant medical record, please state clearly the patient’s Hong Kong Identity Card Number and the required information. 請正確填寫病人身份證號碼及所需資料, 以便翻查記錄。 The applicant must produce in person the original or a true copy of his/her identity document. 申請人必須親身出示其身份證明文件或提交真確副本。 If the applicant is not the patient, a written consent of the patient is required and the applicant must also produce in person the original or a true copy of the patient’s identity document. 申請人若非病者本人, 必須取得病人簽署同意書及出示病人之身份證明文件或提交真確副本。 If the applicant is the patient’s parent or guardian, please produce in person the original or provide a true copy of the documentary evidence to support the relationship. 如申請人是病人之父母或監護人, 請出示能證明申請人與病人之間關係的證明文件或提交真確副本。 A charge between HK$695and HK$2,780 will be levied, depending on the type and number of reports required. Cheque, remittance or money order shall be addressed to “Hospital Authority”. 報告書之收費由港幣六百九十五元起至二千七百八十元, 按所屬類別及專業而定。 申請每份報告書最低需繳交港幣六百九十五元, 所有支票, 匯票及本票請寫明支付「醫院管理局」並加劃線。 No refund of the fee paid for a medical report will be made even if the application is withdrawn before the medical report is issued. 即使在醫療報告書發出前撤銷