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  • MICARE

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    Nurmasnirah Mohd Yunus
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    MiCare Sdn Bhd, formerly known as Metronic iCares Sdn Bhd and located in Shah Alam, Selangor, Malaysia, provides medical claims administration services as a member of the Zuellig Pharma Group. The document includes a Record of Attendance form for patients to authorize the release of their medical visit information to MiCare for processing medical claims, with fields for patient name, IC/passport number, company name, date of visit, and signature.

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    MiCare Sdn Bhd, formerly known as Metronic iCares Sdn Bhd and located in Shah Alam, Selangor, Malaysia, provides medical claims administration services as a member of the Zuellig Pharma Group. The document includes a Record of Attendance form for patients to authorize the release of their medical visit information to MiCare for processing medical claims, with fields for patient name, IC/passport number, company name, date of visit, and signature.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    1K views1 page

    MICARE

    Uploaded by

    Nurmasnirah Mohd Yunus
    MiCare Sdn Bhd, formerly known as Metronic iCares Sdn Bhd and located in Shah Alam, Selangor, Malaysia, provides medical claims administration services as a member of the Zuellig Pharma Group. The document includes a Record of Attendance form for patients to authorize the release of their medical visit information to MiCare for processing medical claims, with fields for patient name, IC/passport number, company name, date of visit, and signature.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    MiCare Sdn Bhd (a member of Zuellig Pharma Group)

    (formerly known as Metronic iCares Sdn Bhd)

    MiCare Sdn Bhd (a member of Zuellig Pharma Group)


    (formerly known as Metronic iCares Sdn Bhd)

    Block A, No. 22 Jalan Astaka U8/84, Section U8,


    Perindustrian Bukit Jelutong, 40150 Shah Alam, Selangor
    Darul Ehsan, Malaysia
    Tel : +603-7839 7200, +603-7843 9459
    Fax : +603-7847 4304, +603-7846 1664
    Website: www.micaresvc.com
    Email: customerservice@micaresvc.com

    Block A, No. 22 Jalan Astaka U8/84, Section U8,


    Perindustrian Bukit Jelutong, 40150 Shah Alam,
    Selangor Darul Ehsan, Malaysia
    Tel : +603-7839 7200, +603-7843 9459
    Fax : +603-7847 4304, +603-7846 1664
    Website: www.micaresvc.com
    Email: customerservice@micaresvc.com

    RECORD OF ATTENDANCE (ROA)

    RECORD OF ATTENDANCE (ROA)


    Name of patient

    IC/ Passport No. of


    patient

    IC/ Passport No.


    of patient

    Company Name

    Company Name

    Date of visit

    I hereby authorise the clinic to release any information related to this visit
    to MiCare Sdn. Bhd, the employer/payor for purpose of processing this
    medical claim.
    Name & Sign :

    Please cut to split. Thank you.

    Name of patient

    Date of visit

    I hereby authorise the clinic to release any information related to this visit
    to MiCare Sdn. Bhd, the employer/payor for purpose of processing this
    medical claim.
    Name & Sign :

    FOR INTERNAL USE ONLY

    FOR INTERNAL USE ONLY

    MiCare panel clinic ID

    MiCare panel clinic ID

    Clinic Stamp

    Clinic Stamp

    Authorized Signature

    Authorized Signature

    YOUR ONE STOP MEDICAL CLAIMS ADMINISTRATOR

    YOUR ONE STOP MEDICAL CLAIMS ADMINISTRATOR

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