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Inpatient & Outpatient Bill Enquiry


All fields marked * 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
Case No:
Case No:
Case No:
Outpatient Bill
Invoice No:
Invoice No:
Invoice No:
Please state enquiry:*
Type the characters you see in the picture below:
 
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