Application for Copies of Medical Record and Report
Precautions for applying for X-ray, CD Rom of image examination copy, copy of medical record, copy of examination report, and certificate of diagnosis.
【Entrusted agent application】
2. Original ID Card of Agent
3. Patient consent form
【Application for minor qualification】
Original ID Card of Legal Representative；
Proof of relationship between legal agent and patient (original account book or original patient ID card).
2. Apply by agent：
Issue the original identity card of the agent；
Proof of relationship between legal agent and patient (original account book or original patient ID card)；
Legal agent's entrustment agreement；
Agent identity card。
2. Proof of relationship with the patient；
3. Certificate of removal of the patient (transcript of household registration or death certificate).
※If this application is made by an agent, the above information and the consent form and the original identity card of the agent must be prepared.
After completing the aforementioned data, please mail to firstname.lastname@example.org
Download relevant supporting documents
For application for replicate medical record or image (x-ray copy and ultrasonic) from the radiation department, file the application to the medical staff during the “clinic hours.” The replicate of the application form will be issued. Confirm the scope and number of copies.
Or, the patient or authorized person shall proceed to the “Replicate Medical Record Application/Collection Office” of Admission Center on the first floor of Lifu Medical Building to fill out the “Medical Record Replication Application Form,” “Imaging Copy Application Form” or “Letter of Authorization” and confirm the scope and copies for application.
Monday to Friday：Morning 08:30- Afternoon 17:00
Evening 18:30-21:00 (limited to application at the clinic)
Saturday: Morning 08:30-12:00
Traditional Film Application Time
Monday to Friday: 08:30-17:00 a.m.
Saturday: 08:30-12:00 a.m.
For application between Lifu Medical Building, First Medical Building, Children's Medical Center, and Rehabilitation Building, please wait and collect at the “Replicate Medical Record Application/Collection Office” of Admission Center (except for imaging and x-ray copy collection).
For application between Meide Medical Building, Critical Care Center Building and Cancer Center Building, please pay at the cashier counter of that building and wait for collection (except for imaging and x-ray copy collection) Critical Care Center Building
Online application: Please pay and collect at the “Replicate Medical Record Application/Collection Office” of the Admission Center (except for imaging and x-ray copy collection.
Imaging and x-ray copy collection：
- For application cases between Lifu Medical Building, First Medical Building, Children's Medical Center, Rehabilitation Building, and Meide Medical Building, please collect at the Radiation Department on the third floor of Lifu Medical Building.
- For application cases between the Critical Care Center Building and Cancer Center Building, please collect at the cashier counter or emergency counter of Critical Care Center Building.
Replicate of medical record summary, medical treatment records, check (examination) report, imaing and X-ray copies take about 90 minutes in waiting
Full medical record copy takes about 3-7 working days.
Chinese medical record summary takes 14 days
- Basic fees for medical record replicates: NT200 (including 10 copies) and additional NT5 per copy.
- Chinese medical record summary：NT650/discipline, 7-14 working days for collection.
- Color examination report and trauma photo printing: Basic fee NT 200 (including five copies) and additional NT40 per print.
- CD Rom: Single examination NT200; for 2-6 examinations, additional NT 50 will apply for each additional examination. Fees for 7 examinations or more is NT500. Each additional CD Rom will be charged of NT100 per CD.
- X-ray film: NT200 per film.Fee standards for Replication of electronic medical record.
- CD Rom: NT200 per CD and NT100 will be charged per each additional CD.
- Self-paid postage: Postal (prompt registered) NT50, courier NT120.