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Hospital Tengku Ampuan Rahimah Klang (HTAR) 2026

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4.8 out of 5

58 votes

The document is a medical report application form from Hospital Tengku Ampuan Rahimah in Klang, Selangor. It outlines the necessary information required from the applicant and patient, including personal details, relationship to the patient, and treatment dates. The form specifies different types of medical reports available for a fee, depending on the complexity. It also includes sections for consent from the patient or their guardian and lists required documents based on the applicant's relationship to the patient. Additionally, it addresses payment details and conditions for foreign nationals.

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Click ‘Get Form’ to open the Hospital Tengku Ampuan Rahimah Klang (HTAR) application form in the editor.
Begin by filling out the 'MAKLUMAT PEMOHON' section. Enter your name, identification number (K.P or Passport), relationship to the patient, address, postal code, and contact numbers.
Next, complete the 'MAKLUMAT PESAKIT' section. Provide the patient's name, identification number, age, gender, clinic/ward details, and treatment dates.
Indicate if there are any outstanding debts at the hospital by selecting 'Ada' or 'Tiada'.
In the 'LAPORAN YANG DIPOHON' section, check the appropriate box for the type of medical report you are requesting.
Ensure you fill in the consent section by signing and providing your details as required.
Finally, review all entered information for accuracy before submitting your application through our platform.

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See more Hospital Tengku Ampuan Rahimah Klang (HTAR) versions

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Versions	Form popularity	Fillable & printable
2024	4.1 Satisfied (41 Votes)
2017	4.8 Satisfied (58 Votes)
2011	4 Satisfied (21 Votes)

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