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Micare helpline 2026

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The document is an Outpatient Reimbursement Claim Form from MiCare Sdn Bhd, detailing the necessary personal and medical information required for employees to claim reimbursement for outpatient services, including clinics, specialists, health screenings, dental, and optical claims. It includes sections for personal details, clinic information, diagnosis, and a declaration for authorization of medical information release.

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Click ‘Get Form’ to open the micare helpline in the editor.
Begin by filling in your personal details. Enter the Company Name, Employee ID, and your full name as well as your NRIC number.
Next, provide the Patient's information including their name and NRIC. Ensure that you also include a valid contact number and mailing address.
In the 'Clinic / Hospital' section, list the names of clinics or hospitals visited along with the reason for the visit. Specify if it was for yourself or a dependent.
Document any diagnoses and receipt numbers related to your claims. Make sure all amounts are accurately recorded in RM.
Review the declaration section carefully. Confirm that all information is true before signing and dating the form.

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Versions	Form popularity	Fillable & printable
2015	4.6 Satisfied (23 Votes)

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