Request for Medical Record

Download Application for Medical Record Form

First, download the Consent Form here download form

If you are requesting for the Medical Record for yourself (Patient)

Complete the Request Form: Fill out the Consent of Application for Medical Record Form.
Provide Identification: A copy of patient’s ID (front and back) – NRIC or passport
Provide other supporting documents related to application/treatment
Submit Your Request:
You can submit the necessary documents to Medical Record Department via
- Walk-in to the Medical Records office at CMH Specialist Hospital (Ground Floor, Block B)
- Email the Medical Records team at medicalrecord@cmhspecialist.my
- Drop a message on WhatsApp to the Medical Records team at +6012-264 5313
If payment is required, the Medical Records team will get in touch with you for payment arrangements.

Once the documents are verified by the Medical Record Department, the medical record will proceed to send the patient’s medical record via

If you are requesting on behalf of patients / deceased patient

Complete the Request Form: Fill out the Consent of Application for Medical Record Form.
Provide Identification:
- A copy of patient’s ID (front and back) – NRIC or passport
- A copy of requestor’s ID (front and back) – NRIC or Passport
- Death Certificate for deceased patient
Authorisation letter signed by the patient. For deceased patient, the authorisation letter should be signed by the patient’s next-of-kin.
Provide other supporting documents related to application/treatment
Submit Your Request: You can submit the necessary documents to Medical Record Department via
- Walk-in to the Medical Records office at CMH Specialist Hospital (Ground Floor, Block B)
- Email the Medical Records team at medicalrecord@cmhspecialist.my
- Drop a message on WhatsApp to the Medical Records team at +6012-264 5313
If payment is required, the Medical Records team will get in touch with you for payment arrangements.

Once the documents are verified by the Medical Record Department, the medical record will proceed to send the patient’s medical record via

Checklist for Medical Report Application

Requestor	Application Form	Consent Form	Patient’s Photocopy ID or birth Certificate	Death Certificate	Requestor’s Photocopy ID	Signed Authorization Letter
Patient	Yes	-	Yes	-	-	-
3rd party on behalf of	Yes	Yes (Signed by patient)	Yes	-	Yes	Yes (if collected by other than patient or requestor)

Contact the Medical Records Department

Request For Medical Record