Call us: +62 (818) 73 1368 | +62 (811) 1999 0203
Email us: info@icare.my.id
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Medical Evacuation Form

    Home Medical Evacuation Form

    Medical Evacuation Form

    Silahkan mengisi form dibawah ini untuk membuat permintaan Medical Evacuation.

    Harap semua informasi yang dibutuhkan diisi dengan lengkap, guna memperlancar proses evakuasi dan administrasi dengan pihak – pihak terkait.

    Keluhan dan Kekhawatiran Pasien

    Kami berkomitmen untuk memberikan perawatan kesehatan berkualitas kepada semua pasien. Jika Anda memiliki kekhawatiran tentang perawatan yang Anda terima, silakan laporkan kepada dokter yang merawat Anda atau hubungi Departemen Hubungan Pasien kami.

    Team kami akan mencatat dan menangani kekhawatiran Anda dengan segera. Setelah tinjauan internal, kami akan menghubungi Anda untuk informasi lebih lanjut dan penyelesaian.

    Please enable JavaScript in your browser to complete this form.
    - Step 1 of 3
    Contact Person *
    If you need an appointment for someone under 18, please provide your own contact details.
    If you need an appointment for someone under 18, please provide your own contact details.

    Patient Information Detail

    Patient Name *
    Date of Birth *
    Patient's Gender *

    Services Details

    Include bed-to-bed transportation? *

    Pick-up and Drop-off Detail

    Patient's Pick-up Location *
    Drop-off Location *
    Have you experienced Covid-19 symptoms in the last 14 days? *
    Have you taken a Covid-19 test in the last 5 days? *
    What was the result of the test? *

    Patients with symptoms who have a positive test result will be offered a telephone appointment. We may also offer a telephone appointment if you're awaiting the results.

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    Head Office

    Equity Tower
    Sudirman Central Business District,
    Jalan Jendral Sudirman Kav 52-53
    Jakarta Selatan, DKI Jakarta, 12190, Indonesia
    Phone +62 (811) 1999 0203

    Branch

    Jalan Danau Singkarak V / E3F.8
    Madyopuro, Kedungkandang, Kota Malang, Jawa Timur, 65139, Indonesia
    Phone +62 (818) 73 1368

    Direct Link

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    Working Hour

    Senin - Jumat : 09:00am - 05:00pm
    Sabtu : 09:00am - 01:00pm
    Minggu dan Hari Besar Nasional : Tutup

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    © Copyright 2021 iCare Health & Wellness | All Rights Reserved
    • Home
    • About Us
      • Greetings
      • Our Specialities
      • iCare Loyalty Cards
    • Our Services
      • Doctor
      • Hospital
        • Rumah Sakit Malaysia
      • Medical Evacuation Sevices
      • Flight & Hote Booking
        • Best Rooms by Trip.com
        • Flight by Trip.com
    • Knowledges
      • Cardiovascular
      • Gastroenterology
      • Ginjal
      • Oncology
      • Orthopaedics
      • Stem Cells
    iCare Health & Wellness