This claim form shall be submitted for pay and file claims or insured policy is on waiting period. Whenever patients admitted to hospital and advisable to claim all the expenses, this form shall be submitted to us for attending consultant.

An attending physician statement normally a questionnaire for a consultant to fill up regarding patients visit due to admission complete with all procedure and investigations done in hospital.

Required documents to send to insurance provider are , total bills of visit to hospital, claims form and all investigation results.

All attending physician’s statement / Hospitalization claims will be charged RM 100/form

Example 1 – Hospitalization Claim

Example 2 – Hospitalization Claim

Example 3 – Hospitalization Claim