Forms

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Listed below are the online forms that are available for download.

HOTA FORMS

Description

Published Date

Organ Donor Form (128KB)

2009



HOTA Opt-out Form (181KB)

2009



Withdrawal of Objection Form (689KB)

2009



Please send the completed forms to the following address:

Officer-in-Charge

National Organ Transplant Unit

c/o Singapore General Hospital

Singapore 169608



For more information, please call the organ donor registry at 63214390.

Note: A person who objects to HOTA will not receive any priority should they require an organ transplant.

 


PREVENTION AND CONTROL OF INFECTIOUS DISEASE ACT

 

Description

 
Published Date

 
Certificate of Vaccination (38KB)

 
2015

 
Certificate of Unfitness for Vaccination against Diphtheria/Measles
 
 
2004
 
Certificate of Measles Infection (85KB)

 
2007

 
Notification of Vaccination                                                                                       

Registered medical practitioners are required to submit notification of vaccinations online ( https://www.nir.hpb.gov.sg/nird/ens/enslogin ) with CorpPass and password.

 

Notification of Unfitness for Vaccination (20KB)

 
2004

Reporting of post-vaccination adverse events:
 

Reporting of post-vaccination adverse events can be made to the Vigilance Branch, Health Products Regulation Group, Health Sciences Authority.

For more information, please visit: http://www.hsa.gov.sg/content/hsa/en/Health_Products_Regulation/Safety_Information_and_Product_Recalls/Report_Adverse_Events_related_to_health_products.html#AEFI

 

 

Notification of Infectious Diseases (120KB)

 
2018
Notification of Tuberculosis (94KB)

 
2016
Tuberculosis Treatment Progress Report (16KB)

 
2007
Cluster Notification Form A (29KB)

 
2007
Cluster Notification Form B (40KB)

 
2007
Letters to parents / guardians (for MCDS licensed preschool centres) (62KB)

 
2004
Letters to parents / guardians (for MOE registered preschool centres) (62KB) 2004


PARTICIPATION IN CHRONIC DISEASE MANAGEMENT PROGRAMME (FOR MEDICAL INSTITUTIONS)

Description

 
Published Date

 
Overview Document (61KB) Sept 2008

 
eRegistration Website Sept 2008


FORM FOR MAKING OF ADVANCE MEDICAL DIRECTIVE (AMD)
 

Description

 
Published Date

 
Advance Medical Directive (AMD) form (224KB)

 
2005

 
The form may takes you 5 minutes to fill in. Notes on printing:
This form should be printed on 1 sheet of paper (i.e. print the two pages of the form on both sides of one sheet of paper).
This form is in Adobe Acrobat format. If you do not have the reader, please download the free Adobe Reader first, before you proceed to print the form.
 


Related Info:

Advance Medical Directive Act

 


FORMS FOR COMMUNITY HEALTH ASSIST SCHEME (CHAS)

 

Description

 
Published Date

 

Application Form for CHAS
 

Application form for Community Health Assist Scheme (1.7MB)

Sep 2016

 


APPLICATION FOR APPROVAL TO PERFORM VOLUNTARY STERILISATION

 

Description

 
Published Date
 
Status of Approved Institution (80KB) 2004

 
Report on Treatment for Sexual Sterilization
 
2012

 
Licensing Terms and Conditions for Sexual Sterilization
 
2012

 
Circular for Voluntary Sterilization, and Guidance for Healthcare Institutions and Medical Practitioners Performing Sexual Sterilization
 
2012

 
Certificate of Sexual Sterilization
 
2012

 
Consent for Treatment for Sexual Sterilization 2012

 


APPLICATION FORMS TO CARRY OUT CLINICAL OR RESEARCH WORK IN ASSISTED [REPRODUCTIVE TECHNOLOGIES]

 

Description

 
Published Date

 
For ARP (81.5KB)

 
2004

 
Authorization Form for an Embryologist (75KB )

 
2004

 
Authorization Form for an O&G Specialist (74KB)

 
2004

 
Extension for an Embryologist (69KB)

 
2004

 
Extension for an O&G Specialist (68KB)

 
2004

 
Deviations from the Guidelines for Private Healthcare Institutions (59KB)

 
2004
 


APPLICATION FOR APPROVAL TO PERFORM TERMINATION OF PREGNANCY
 

Description

 
Published Date

 
Status of Approved Institution (82KB)

 
2004

 
Application Form for Authorization to Terminate Pregnancy (13KB)

 
2004

 
Report on Request for Treatment to Terminate Pregnancy (103KB)

 
2015

 
Return on Provision for Termination of Pregnancy Counselling (13KB)

 
2004

 
Consent Form for Termination of Pregnancy (49KB)

 
2004

 
Termination Of Pregnancy Act Declaration Form (49KB)

 
2004

 
HPB Counselling Centre Referal Form (72KB) 2004



FORMS FOR FUNDINGS AND MEDICAL RESEARCH (FOR INSTITUTIONS OF PUBLIC CHARACTER)

Description

 
Published Date

 
Form 4 - Application for IPC Status (113KB)

 
May 2007

 
Form 5 - Annual Return of Tax Deductible Donations (45KB)

 
May 2007

 
Form 6 - Annual Submission for IPC (General Account) (62KB)

 
May 2007

 
Form 7 - Annual Submission for IPC (Specific Account) (69KB)

 
May 2007

 
Auditor Declaration Form (38KB)

 
April 2008

 
Related Info:

Fundings and Medical Research (IPC)
 


VWO CONTINGENCY FUND APPLICATION
 

Description

 
Published Date

 
VWO Contingency Fund - Cover Letter (2nd call) (76KB)

 
Dec 2009

 
VWO Contingency Fund Application Form (26KB) Feb 2009

 


CONTACT TRACING TEMPLATE

 

Description

 
Published Date

 
Hospital Contact Tracing Template (144KB)
 
2014
 
Institution Contact Tracing Template (353KB) 2014

 

Activity Mapping Template (159KB)
 
2014


MEANS-TEST DECLARATION FORMS

 

Description

 
Published Date

 

Means-test Declaration Form

Business Reply Envelope for Means-test Declaration Form

Aug 2017
Financial Assistance Declaration Form

Apr 2015

2004
 


MEDICAL CLAIMS AUTHORISATION FORMS


Description


Published Date


Medical Claims Authorisation Form (Single Institution)

May 2016
Medical Claims Authorisation Form (Multiple Institutions)

May 2016


Revocation Form for Medical Claims Authorisation (Multiple Institutions)

June 2015