Section A: Clinic Details

Basic Information

 

Person-in-Charge

Address Details

Contact Details

Bank Account Details

Section B: Workforce. Number of Staff

Total clinic staff

Specialist medical practitioner

Non-specialist medical practitioner

Pharmacist

Assistant medical officer

Practice nurse (diploma/degree in nursing)

Community/home care nurse (certificate in nursing)

Clinic assistant

Receptionist/clerk

Section C: Services Provided In The Clinic


patients / day

Section D: Electronic Health Records

Does the clinic use a computer system?

Acceptance of Terms of Service, Privacy Policy

Section E: Document Upload

Certificate of registration to operate private medical clinic (Borang B or Borang F)

MMC full registration certificate of person-in-charge

Current annual practising certificate (APC) of person-in-charge (APC 2019)

Proof of Bank Account