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S$50.00* Laboratory & Radiology Investigations Chest X-Ray: Tuberculosis Detection X: HIV Screen Other Services Doctors endorsement on medical examination report upon medical examination Courier service of endorsed medical examination report to institution within three (3) working days
(from date of students medical examination)
Doctors Examination
* Price listed is subject to prevailing GST and also subject to change without prior notice.
FOR APPOINTMENT To make an appointment for our Health Screening packages, please contact the Health Enrichment Centre @ Tan Tock Seng Hospital at: Hotline: Email: Website : 6357 2233 / 2235 HEC@ttsh.com.sg http://www.ttsh.com.sg/healthenrichmentcentre/
ON YOUR APPOINTMENT DAY Please bring along your: o Passport o This Copy of Medical Examination Report We are located at : Health Enrichment Centre Level 1 Tan Tock Seng Hospital 11 Jalan Tan Tock Seng, Singapore 308433 LOCATION MAP OF HEALTH ENRICHMENT CENTRE @ TAN TOCK SENG HOSPITAL
I Personal Particulars
1. Name (as in the passport): 2. Sex: M / F 3. Date of Birth : 4. Nationality : 6. FIN No. (if applicable) :
II Medical Examination
I certify that the above-named has undergone a chest x-ray and the result of his/her chest X-ray is as indicated (with a []):Yes 1. TB (Chest X-ray)* Any evidence of active TB detected?
[*Pregnant Women are exempted from Chest X-Ray]
No
I certify that I have tested the above-named and the result of his/her HIV test is indicated below (with a tick []). Positive 2. HIV : Name of Examining Doctor (IN BLOCK LETTERS): Signature : Date: MCR no: _______________________ Clinics Stamp & Address: Telephone Number : Negative/Non-Reactive
NOTE: For persons screened overseas, the name in the laboratory report for HIV and the X-ray report must be according to the name shown in the Passport.
DECLARATION
I,
(name)
I have submitted a medical report** containing the above information to Immigration & Checkpoints Authority / Ministry of Manpower*** (not more than two years ago) when I was granted the
(pass type)
on
(dd/mm/yy)
valid till
(dd/mm/yy)
** Those who were previously exempted from submitting the X-ray report because of pregnancy are required to submit a X-ray report certified by a Singapore registered GP, if you are not pregnant now. *** Delete where necessary.
WARNING:
Version 4 (4 Oct 07)
IT IS AN OFFENCE UNDER THE IMMIGRATION ACT TO MAKE ANY FALSE STATEMENT, REPRESENTATION OR DECLARATION
Adapted: Medical Examination Report. Version 4 (4 Oct 07). Available from http://www.ica.gov.sg/data/resources/docs/Visitor%20Services/MedicalReport.pdf