1. This form must be duly completed and signed by the patient. If the patient is below 21 years old, the form should be signed by the patient’s parent.

  2. If the patient is deceased / incompetent, consent is required from the authorised representative. Authorised representatives are to provide photocopies of their NRIC or passport, Court Orders, Lasting Power of Attorney and / or other legal where applicable. A copy of the patient’s death certificate is required. If an authorised representative has not been appointed, a separate Authorisation to Release Medical Records has to be completed by all family members of the patients.

  3. Photocopies of relevant documents (e.g. birth certificate, marriage certificate and letters of administration) are to be attached as proof of relationship to patient if applicable.

  4. The completed form must be submitted with the appropriate fee at the clinic.

  5. Dr. Jonathan Lee Yi-Liang Hand & Upper Limb Surgery reserves the right to refuse a request for the release of patient medical information if Dr. Jonathan Lee Yi-Liang Hand & Upper Limb Surgery finds that such persons do not have the authority to make such requests.

  6. The release of medical information is subject to the official approval.