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Medical Report Request Form
Please read the
instructions/guidelines
before applying
If you are requesting access to your health information then please complete all Mandatory fields.
*
If you are a representative or parent/guardian, please specify in “Requester Information” section and provide your Qatar ID.
If the application is rejected, you will receive an SMS/Email.
The request form will be reviewed and processed by HMC Health Information Management Department, you will receive an SMS/Email to inform you when your request is completed.
*
Health Card Number:
(Enter 8 digit Health Card Number)
*
Patient Name:
(Enter Patient Name as shown on QID or Health Card)
*
Mobile Number:
*
Email:
I confirm that this email is correct for sending the confidential clinical information as per the request
Processing Request...
