@ Si, JA Internationa Assistance Sdn Bh “-* International DEFERMENT LETTER 16 Baru Sungai Wey 47200 Assistance Sdn. Bhd. ect ISLAND HOSPITAL hy 30 Nov 2021 18:35:24 NO.308, MACALISTER ROAD the 267416-1/DF/2 Attention : DR. BADRUL HISHAM YEAP Patient Name | HENDRA Company | ALLIANZ LIFE-HS CARE PREMIER XTRA Employee Name | HENDRA Plan Code | HSX5-ESSENTIAL-X IC / Card No €2690354/8000210118213626 | Diagnosis_ | AMPULLARY CANCER STAGE IIT DOB / SEX :1980-10-20/M ‘Admission | 2021-11-19 ‘Thank you for providing medical treatment for our member as above. 1. Based on your history taking the details of previous stents placed (even not at your facility) should have been noted before a new7mm stent placed by yourself. Hence, please clarify when was the previous stents placed? aa fer fo te rey 4 Oy Bedut ths Ure ated Phe pot Hows. 2. Please clarify the indication for the stdhts to be replaced. ba Zrdlony & . fe ow I brder be i/o} 3. Please attach the medical treatment request letter recelved from the member requesting fon your services and/or your written request to MHTC prior to this hospitalisation. 5 pose? M vo ROM ybo Pee 222 peak) eri ax OM Thank you. Yours sincerely, L rex DATE time | USER 2021-11-30 | 06:25 | Muzammil Muzammil This is a computer-generated document. No signature is required.x Va nf ISLAND HOSPITAL 306 Macaetr Road, 10850 Penang, Malays ty HOSPTAL Y.16042208222 | F: 6042267989 | _Wewwmislandhospkalcor | fuland Hospitl Sd, Bhd (Company Nos s2070Sa) lear” DATE D/ V1 REF NO. \ Al- SO4G TZ Malaysia Healthcare Travel Council Level 28, Tower 2 Menara Kembar Bank Rakyat. Jalan Rakyat, 50470 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur SUBJECT *APPUCADON PETER MEDICAL TREATMENT i ORR PASSPORT NUM. i 02854 COUNTRY OF ORIGIN: |NDS\ ESV MEDICAL TREATMENT DETAILS ef exeing Brief History (intuding procedure has been performed) Clinical Diagnosis Planned Treatment and Estimated Duration Mode of Transportation (Medical Evacuation Chartered Flight /, Flight / Ambulance)cross any unrelated item Private Jet/ Chartered Ferry/Commercial ACCOMPANYING RELATIVE DETAILS (if any limited to only 1 accompanying relative except for pediatric case, 2 accompanying relatives are allowed) Name Passport Number Country of Origin Relationship | Remarks (if any) WHR Torr Cotas Wesvent Wipe = Thank you for your kind assistance in facilitating the entry of this patient to Malaysia, Your faithfully, ~BADRUL HISHAM YEAP MO USM, MRCS (Edn), FRCS Oe Felluniipin Pecos Sager, al TN: 34489, WOR: 127229) [Company Stamp] Consultant General & Paediatric Surgeon [MMC No.] ISLAND HOSPITAL, Declaration: signing this form, both hospitals ave cavenent ond undertake tha they have procured the written consent ofthe HT and/or HT companions) (if any) whose persona data is callected and the HT and/or HF companions) has agreed that thelr personel ota wil be shored with MHTC for the purpose of eppicaticn t enter Malaysia during MO. The hospital) shal Inemiy BTC n {lin the event the HT and/or HT companions fle @caim agonst MTC)Reference no.: Date: MALAYSIA HEALTHCARE TRAVEL COUNCIL (Company No.: 201101035226(963360-K)), Level 28, Lot 26-01, Tower 2, Menara Kembar Bank Rakyat, Jalan Rakyat, 50470 Kuala Lumpur, Attention: Vice President of Facilitation LETTER OF CONSENT FOR NON-MALAYSIAN CITIZEN TO TRAVEL TO MALAYSIA FOR MEDICAL TREATMENT DURING MALAYSIA MOVEMENT CONTROL ORDER ("MCO") (b) (c) (3) (e) ® (9) (n) to comply with the observation and surveillance of Covid-19 contacts order pursuant to Section 15(1) of the Prevention And Control of Infectious Diseases Act 1988 (Act 342] and other directives issued and enforced by Government of Malaysia from time to time before and during my/our visit to seek medical treatment in Malaysia under the care of the. ISLAN' TAL (“Hospital”); to undergo Covid-19 test by way of polymerase chain reaction ("PCR") In mylour Country of origin or country of residence, three (3) days before my/our expected arrival in Malaysia; to be isolated for a continuous period of 7/10 days at the Hospital upon my/our arrival In Malaysia (“Isolation Period”); to undergo Covid-19 test by way of PCR for the second time at the Hospital upon my/our arrival; to undergo Covid-19 test by way of PCR for the third time at the hospital on day 5/8 of the isolation Period; in the event that either myself or my companion is tested positive after taking the test, live shall adhere to all the directives, procedures or guidelines Imposed from time to time by the Govemment of Malaysia; that my/our personal data shall not be disclosed to any other party excapt relevant authorities in Malaysia for the purpose of this arrangement and Uwe shall indemnify MHTC and keep MHTC indemnified in the event there is any discrepancy on the data provided; we shall indemnify and keep MHTC, its employees and agents harmless from and against all actions, proceedings, losses, shortfalls, damages, compensation, costs (including legat costs), resulting from our actions, negligence of melus or the hospital and/or omission of material facts to the Hospital during the Observation and Surveillance (isolation) Period; and 142(that allgisputes (it any) regarding this Lotter shall be governed by and interpreted in accordance with the laws for the time being in force in Malaysia and exclusive Jurisdictions of the courts in Malaysia. MWe heroby acknowledge that Uwe have read the terms end conditions as set out inthis Latter ‘of Consent and fully understand the contents herein, ‘Yours sincerely, Full name (Patient): WENDRA \RANSTAH Passport No.: C 2680384 Date: o1- 1-207) Full name (Companion): Lowa TIANORA Passport No: C 2400355 Date: o1-n- 2024 212