Medical Report and Patient Information Application Form - www3 ha org 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by completing Part A, which includes the Patient’s Particulars. Fill in the patient's name in both English and Chinese, select their sex, and provide the HKID/Passport number along with the date of birth.
3. Indicate the number of reports or certificates required and provide a daytime telephone number. Ensure you also include the correspondence address for report delivery.
4. Move on to Part B to specify the information requested. Check the appropriate boxes for nature of request, purpose of application, and relevant departments or clinics.
5. If applicable, complete Parts C and D for patients under 18 years old, including details about their parent or legal guardian.
6. For authorized agents applying on behalf of patients, fill out Part E with their particulars and ensure signatures are provided where necessary.
7. Finally, review all sections for accuracy before submitting your application form through our platform.

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