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   Inpatient & Outpatient Bill Enquiry

All fields marked with are required

Name of Enquirer :
NRIC of Enquirer :
Relationship to Patient :
Address :
Email :
Telephone/Handphone :
Fax:
Name of Patient :
Patient's NRIC/BC
Type of Bill :
Hospitalisation Bill
i.   Case No.         
ii.  Case No.         
iii. Case No.         
Outpatient Bill
i.   Tax Invoice No. 
ii.  Tax Invoice No. 
iii. Tax Invoice No. 
Question/Comment :