Application for Medical Certificate

◎ Application instructions for issuing medical certificates, duplicating medical records, or X-ray films. To ensure patient privacy, please prepare the following documents when applying: (1) Application in person: Please bring the original of your ID card or household registration booklet (2) Application by proxy: Please bring the original ID card (or household registration booklet) and seal of both the patient and the proxy, and fill out the Power of Attorney and Consent Form for Medical Records and Related Documents ( ) Type of Medical Certificate Applicant Required Documents for Applicant Application Process Fee Remarks Type A Medical Certificate Self ID Card Registration→Doctor Issues→Payment→Official Seal→Receive Medical Certificate NT$1000/copy Type B Medical Certificate Self ID Card Registration→Doctor Issues→Payment→Official Seal→Receive Medical Certificate NT$100/copy NT$50/copy for duplicate English Medical Certificate Self ID Card Registration→Doctor Issues→Payment→Official Seal→Receive Medical Certificate NT$200/copy Labor Injury and Illness Medical Certificate Self ID Card Registration→Doctor Issues→Payment→Official Seal→Receive Medical Certificate NT$200/copy Labor and Farmer Insurance Disability Medical Certificate (Non-hospital format) Self ID Card Registration→Doctor Issues→Payment→Official Seal→Cover given to family (patient), the entire set of documents sent by the hospital to the Bureau of Labor Insurance NT$500/copy Death Certificate Immediate Family Immediate Family ID Card and Household Registration Booklet Registration→Doctor Issues→Payment→Official Seal→Receive Certificate NT$40/copy Free for up to three copies, NT$40 for each additional copy Catastrophic Illness Certificate Self ID Card Registration→Doctor Approves Issuance→Go to Counter to Photocopy Documents for Review of Catastrophic Application Data→Counter Receives NT$100/copy Medical Record Duplication Self ID Card Fill out application form at counter Basic fee NT$200 (includes 10 pages), NT$5 for each additional page Disability Medical Certificate for Family Application to Employ Caregiver Self ID Card/2 Photos Registration→Doctor Approves Issuance→Payment→Official Seal→Cover given to family (patient), the entire set of documents sent by the hospital to the Long-Term Care Center NT$1000/copy Remarks: 1. When a non-patient comes to the hospital to issue a medical certificate, the authorized person must present the patient's power of attorney and original identification documents (ID cards) of both parties. 2. Inpatients who wish to apply for a medical certificate should inform the nursing station during hospitalization or when processing discharge.

Medical Record Application and X-ray Disc Application Process and Form

Procedure for Applying Online for Medical Record Photocopies Regulations for Releasing Medical Records: According to Article 71 of the Medical Care Act, medical institutions providing copies of medical records should, in principle, require applications from the patient or their legal representative. Applications made by individuals other than the patient or their legal representative must be accompanied by a power of attorney from the patient or their legal representative, specifying the purpose and scope of the authorization, before they can be processed. Our hospital's medical record application service hours are as follows: 1. On-site application processing hours: Monday to Friday (08:00~17:30) Saturday (08:00~12:00). During other times, only applications are accepted. 2. Collection hours: Monday to Friday (08:00~21:30) Saturday (08:00~12:00). Application Instructions: 1. Medical records can be applied for using two methods: "on-site application" or "online application". 2. For "on-site application", please proceed to the billing counter on the first floor.   For "online application", please fill out the Medical Record Copy Application Form and Power of Attorney  2.1 For personal application and self-collection, only the Medical Record Copy Application Form needs to be filled out  2.2 For applications or collections by proxy, an additional Medical Record Copy Power of Attorney needs to be filled out             ▲Our hospital offers online applications. The public is welcome to make good use of this service to save waiting time. Required Documents: 1. Personal application: Original ID card of the applicant. 2. Application by proxy: Original ID cards of both parties (patient and authorized person) and a completed "Power of Attorney" form. 3. Application for minor's data by proxy (requires consent from the "legal representative": Must provide the original ID card of the legal representative, the original ID card of the patient, household registration book, the legal representative's "Power of Attorney", and the original ID card of the authorized person. 4. Application for deceased person's data: Must provide the original ID card of the heir, proof of relationship with the patient, and the patient's household deregistration certificate (household transcript or death certificate). If this application is made by a proxy, all the aforementioned documents, a power of attorney, and the original ID card of the proxy must be provided. Processing Time: 1. Application processing takes 1~3 working days, Chinese medical record summary (takes 7-14 working days). Please leave your contact number. After the medical record copying is completed, our hospital will proactively notify you by phone to pay and collect the documents at the billing counter. We apologize for any inconvenience caused. 2. The actual collection time may vary depending on the medical record's condition, and collection may be delayed (those with delayed collection will be notified by phone separately). 3. Applications not collected within one month will be considered void. If needed, please re-apply and pay the fee (For online applicants, if documents are not collected by the deadline, online applications will not be accepted for three months). Application Fees: "On-site Application": "Online Application": Collection Location: