Subject: LIST OF APPOINTED PANEL HOSPITALS FOR APPEAL CASES THAT

REQUIRE MEDICAL SPECIALIST ASSESSMENT & THE NEW APPEAL PROCEDURES

Dear Valued Customers,

Thank you for your patience and continuous support in our effort to strengthen the integrity of
appeal process.

Please be informed that we have appointed a few specialist hospitals as panel to perform
additional tests for appeal cases that require medical specialist assessment. Kindly Refer to
Attachment 1.

Employers/ agencies are advised to register the appeal through the online portal. A processing
fee of RM15 will be charged per disease. Other additional fees are to be paid to the referred
appeal clinic/hospital based on the fee schedule Attachment 2.

Employers/ agencies must obtain a referral letter from the examined clinic and schedule an
appointment with the respective appeal hospital prior to bringing the foreign worker for the
specialist assessment. Kindly Refer to Attachment 3.

Should you require further information, do not hesitate to contact our Customer Service &
Support at cs@fomema.com.my or visit FOMEMA website at www.fomema2u.com.my

Thank you for your cooperation and understanding.

Best regards,

FOMEMA SDN BHD

Attachment 1
 Attachment 2

SCHEDULE 1 – Fees for The Additional Tests

LABORA
CLINIC TOTAL
TORY
FEE*** FEE
NO. ADDITIONAL TESTS SCOPE OF WORKS FEE
(RM) (RM)
(RM)

● Verify the identity of the

foreign worker.
Assess level of FBS and ● Perform phlebotomy, take
HbA1C blood sample and request
1 45 25 70
lab for FBS and HBA1C
(to determine severity of testing.**
Diabetes Mellitus) ● Review/ submit reports to
FOMEMA.
● Verify the identity of the
foreign worker.
Measure blood pressure
● Perform blood pressure
reading
measurement and prepare 45 - 45
2
(to determine severity of BP assessment report.**
Hypertension) ● Review/ submit reports to
FOMEMA.
Urine albumin test lab report
for fresh urine sample:
Repeat test for urine
3 albumin ● Verify the identity of the 45 15 60
foreign worker.
● Submission of the
above report.
● Verify the identity of the
Assess latest vision/aided foreign worker.
visual acuity ● Perform vision test with
4 Snellen Chart and prepare 45 - 45
(to determine severity of visual acuity report.**
poor vision) ● Review/ submit reports to
FOMEMA.
● Verify the identity of the
Repeat chest X-ray foreign worker.
examination ● Perform chest X-ray
5 examination and prepare 40 - 40
(Only for non- chest X-ray report**
Tuberculosis case) ● Review/ submit reports
to FOMEMA.
● Verify history of any drug
consumption
Request for confirmation
● Request lab to perform
test
6 GCMS test on the primary/ 35 310 345
original urine sample.
(Case of opiate positive)
● Review/ submit reports to
FOMEMA.
 LABORA
CLINIC TOTAL
TORY
FEE*** FEE
NO. ADDITIONAL TESTS SCOPE OF WORKS FEE
(RM) (RM)
(RM)

● Verify history of any drug

Request for confirmation consumption
test ● Request lab to perform
7 GCMS test on the primary/ 35 255 290
(Case of cannabis original urine sample.
positive) ● Review/ submit reports to
FOMEMA.
● Verify history of any drug
Request for confirmation
consumption
test
● Request lab to perform
8 GCMS test on the primary/ 35 500 535
(Case of
original urine sample.
methamphetamine
● Review/ submit reports to
positive)
FOMEMA.
● Verify the identity of the
Repeat test for Serum
foreign worker.
Beta-HCG
● Perform phlebotomy, take
blood sample and request
9 (Only if the initial test 45 35 80
lab for Serum Beta-HCG
result of the primary/
testing.**
original sample is
● Review/ submit reports to
indeterminate)
FOMEMA.
 SCHEDULE 2 – Fees for The Additional Tests by Medical Specialist

CLINIC SPECIALIST
ADDITIONAL TOTAL
NO. SCOPE OF WORKS FEE*** REPORT
TESTS FEE (RM)
(RM) FEE**** (RM)

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

● Specialist assessment
Hypertension
1 report to rule out end organ 35 262 297
(Re- appeal)
damage and for fitness for
employment.
● Reported by internal
medicine specialist/ family
medicine specialist.
● Submission of the above
report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

● Specialist assessment
Diabetes
2 Mellitus report to rule out end organ 35 484 519
(Re-appeal) damage and for fitness for
employment.
● Reported by internal
medicine specialist / family
medicine specialist/
endocrinologist.
● Submission of the above
report.
 CLINIC SPECIALIST
ADDITIONAL TOTAL
NO. SCOPE OF WORKS FEE*** REPORT
TESTS FEE (RM)
(RM) FEE**** (RM)

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

Heart disease ● Specialist assessment
3 (including CTR for fitness for 35 740 775
>55 case) employment including
Echocardiogram (ECHO)
report.
● Reported by
cardiologist.
● Submission of the
above report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

● Specialist assessment
4 Urine albumin report to rule out end organ 35 298 333
(Re-appeal) damage and for fitness for
employment.
● Reported by internal
medicine specialist/
nephrologist/ urologist.
● Submission of the above
report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

Skin disease ● Specialist assessment for
5 35 700 735
(Leprosy) fitness for employment
including slit-skin/skin
biopsy test report.
● Reported by
dermatologist.
● Submission of the
above report.
 CLINIC SPECIALIST
ADDITIONAL TOTAL
NO. SCOPE OF WORKS FEE*** REPORT
TESTS FEE (RM)
(RM) FEE**** (RM)

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

● Specialist assessment for
fitness for employment
Goitre/ Thyroid including Thyroid
6 35 461 496
abnormalities Function Test (TFT) lab
report.
● Reported by internal
medicine specialist/
endocrinologist/ general
surgeon/ Endocrine &
Breast Surgeon.
● Submission of the above
report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

7 Vision test ● Specialist assessment 35 408 443
abnormal for fitness for
employment.
● Reported by
Ophthalmologist.
Submission of the
above report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

8 Anaemia/ pallor ● Specialist assessment 35 495 530
for fitness for
employment.
● Reported by internal
medicine specialist.
● Submission of the above
report.
 CLINIC SPECIALIST
ADDITIONAL TOTAL
NO. SCOPE OF WORKS FEE*** REPORT
TESTS FEE (RM)
(RM) FEE**** (RM)

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Defective Role of medical specialist:

hearing/ ● Specialist assessment 35 380 415
9
deafness report for fitness for
employment.
● Reported by ENT
specialist.
● Submission of the above
report.
Role of Registered Doctor:
● Referral letter for
specialist assessment
report.

Role of medical specialist:

● Specialist assessment
10 Bronchial report for fitness for 35 396 431
asthma employment.
● Reported by internal
medicine specialist/
respiratory medicine
specialist.
● Submission of the above
report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

● Specialist assessment
11 Peptic ulcer report for fitness for 35 633 668
employment.
● Reported by internal
medicine specialist/
gastroenterologist/ general
surgeon.
● Submission of the above
report.
 CLINIC SPECIALIST
ADDITIONAL TOTAL
NO. SCOPE OF WORKS FEE*** REPORT
TESTS FEE (RM)
(RM) FEE**** (RM)

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Psychiatry Role of medical specialist:

12 35 293 328
● Specialist assessment
disorder
report for fitness for
employment.
● Reported by psychiatrist.
● Submission of the above
report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

● Specialist assessment
35 1,680 1,715
13 Epilepsy report for fitness for
employment.
● Reported by internal
medicine specialist/
neurologist.
● Submission of the above
report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Breast Role of medical specialist:

abnormalities/ ● Specialist assessment
14 35 693 728
swelling/ lump/ report for fitness for
mass employment.
● Reported by general
surgeon/ endocrine and
breast surgeon.
● Submission of the above
report.
 CLINIC SPECIALIST
ADDITIONAL TOTAL
NO. SCOPE OF WORKS FEE*** REPORT
TESTS FEE (RM)
(RM) FEE**** (RM)

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Limb Role of medical specialist:

abnormalities/ ● Specialist assessment 35 434 469
15
scoliosis/ report for fitness for
kyphosis employment.
● Reported by orthopaedic
surgeon.
● Submission of the above
report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

16 Cancer/ mass 35 604 639
● Specialist assessment
report for fitness for
employment.
● Reported by oncologist.
● Submission of the above
report.
a) Abnormal X-ray with sign of
Tuberculosis infection;

Role of Registered Doctor:

● Referral letter for
specialist assessment
report.

Role of medical specialist:

● Specialist assessment
report for fitness for 35 1,055 1,090
17 employment including TB
Quantiferon and
Abnormal chest GeneXpert lab report.
X-ray ● Reported by respiratory
specialist.
(Only for case ● Submission of the above
of abnormal report.
chest X-ray
without medical
history of
 CLINIC SPECIALIST
ADDITIONAL TOTAL
NO. SCOPE OF WORKS FEE*** REPORT
TESTS FEE (RM)
(RM) FEE**** (RM)

Tuberculosis b) Abnormal X-ray due to non-

infection/ Tuberculosis infection;
treatment)
Role of Registered Doctor:
● Referral letter for
specialist assessment
report.

Role of medical specialist: 35 1,055 1,090

● Specialist assessment
report for fitness for
employment.
● Reported by internal
medicine specialist.
● Submission of the above
report.

Role of Registered Doctor:

● Referral letter for
specialist assessment
Repeat test of report.
Serum B-HCG
positive Role of medical specialist:
● Specialist assessment 35 330 365
18
Only for case report for fitness for
of “not- employment.
pregnant” ● Reported by Obstetrics &
condition Gynaecology specialist.
● Submission of the above
report.
 Attachment 3

APPEAL REFERRAL LETTER FOR SPECIALIST ASSESSMENT REPORT

To Consultant / Specialist (FOMEMA Appeal Panel)

Name of Panel Hospital

Date of Referral

This FOMEMA appeal case is referred for your assessment in regard to evaluation of any end organ
damage and to determine the fitness for employment. The details of the case as below:

Particulars of Foreign Worker

Name of Foreign Worker

Passport No. /
FOMEMA Worker Code

Case Summary

• Date of FOMEMA medical

examination

• Reason for unsuitability

(why failed FOMEMA test)

• Key findings during

FOMEMA medical
examination

• Latest laboratory test

results (if applicable)

• Current Diagnosis

Information of Referring Doctor

Name of Doctor

Contact No.

Clinic Name Signature of Doctor & Official Stamp