Ramathibodi Hospital Administration provides medical record requirement for patient referral and medical certificate for insurance procession.

Open for service on working hours

(Monday - Friday : 08.30 - 16.30)  

Except weekend and public holidays 

Call 02-201-1050

Patient Medical Record Requirement

F-WI-277/01 Patient Medical Record Requirement Form (For Patient)
F-WI-277/02 Patient Medical Record Requirement Form (For Authorized Person)
F-WI-277/03 Letter of Consent and Power of Attorney for Disclosure of Patient's Medical Record Form

Medical Record Requirement for Insurance Procession
F-WI-277/03 Letter of Consent and Power of Attorney for Disclosure of Patient's Medical Record Form
F-WI-278/01 Medical Record Requirement for Insurance Procession Form (For Patient)
F-WI-278/02 Medical Record Requirement for Insurance Procession Form (For Underage)
F-WI-278/03 Medical Record Requirement for Insurance Procession Form (For Deceased Patient)
F-WI-278/07 Medical Record Requirement for Insurance Procession Form (For Authorized Person)

** Please attach documents that according to the form on the date of contact **