RHI Member's Record of Attendance

Hidden
Visit Date*
DD slash MM slash YYYY
Full Name (as per NRIC)*
Last 4 Characters of NRIC*
Example: 123A
Do you wish to receive a email confirmation?*
Email
A confirmation email will be sent to you for your reference
Company Code/ Name*
Hidden
Region*
Hidden
Clinic*
Declaration of Visit*
I confirm that I have received medical attention and/or treatment from the above panel clinic of Raffles Health Insurance and hereby authorised the clinic to release my personal data (including but not limited to medical information) to my employer/payer for purpose of verifying the claim.
Yes, I agree
CAPTCHA
Hidden
Zone*
Hidden
Select Clinic
Hidden
Clinic's Location (Central)*
Hidden
Clinic's Location (East)*
Hidden
Clinic's Location (North)*
Hidden
Clinic's Location (North East)*
Hidden
Clinic's Location (West)*