Subject: LATEST NOTICE UPDATE – LIST OF APPEAL PANEL HOSPITAL

Dear Registered Doctors (D-code),

We would like to thank everyone who have been assisting FOMEMA in managing new appeal
process since 16th December 2023. We believe that the new Appeal process will streamline
and strengthen the integrity of the appeal process, and at the same time, protecting
employers/agents from unnecessary charges by irresponsible parties when processing appeal
cases. Please be reminded that we have published earlier via notice the same appeal process
flow chart (Attachment 1) and Additional Fees schedule (Attachment 2) for your kind
attention.

All Registered Doctors are advised to make sure the employers/agency make advance
payments for clinic fee first before issuing any referral letter for medical specialist assessment
to Appeal Panel Hospital appointed by FOMEMA as listed in (Attachment 3). Please use the
referral form (Attachment 4) when issuing the referral letter for the appeal case (kindly use
additional sheet if required).

We also request your cooperation to advise employer/agency that for every referred case,
they must make advance payment to the referral Appeal Panel Hospital for the cost of medical
specialist assessment report as per attached fee schedule. Your cooperation is greatly
appreciated, and we would like to thank you in advance.

Rest assured that the above Appeal procedures are only temporary until our new Appeal
Online System goes live to serve you better.

Should you have any questions or require assistance, do not hesitate to contact our support
team at cs@fomema.com.my or visit FOMEMA website www.fomema2u.com.my

Thank you for your cooperation and understanding.

Best regards,

FOMEMA SDN BHD

 Attachment 1
APPEAL PROCESS FLOW CHART
 Attachment 2
SCHEDULE 1 – Fees for The Additional Tests

TOTAL FEE (RM)

LABORATORY
CLINIC FEE***

FEE (RM)
(RM)
NO. ADDITIONAL TESTS SCOPE OF WORKS

• Verify the identity of the

foreign worker.
Assess level of FBS and • Perform phlebotomy, take
HbA1C blood sample and request
1 45 25 70
lab for FBS and HBA1C
(to determine severity of testing.**
Diabetes Mellitus) • Review/ submit reports to
FOMEMA.
• Verify the identity of the
foreign worker.
Measure blood pressure
• Perform blood pressure
reading
measurement and prepare 45 - 45
2
(to determine severity of BP assessment report.**
Hypertension) • Review/ submit reports to
FOMEMA.
Urine albumin test lab report
for fresh urine sample:
Repeat test for urine
3 albumin • Verify the identity of the 45 15 60
foreign worker.
• Submission of the
above report.
• Verify the identity of the
Assess latest vision/aided foreign worker.
visual acuity • Perform vision test with
4 Snellen Chart and prepare 45 - 45
(to determine severity of visual acuity report.**
poor vision) • Review/ submit reports to
FOMEMA.
• Verify the identity of the
Repeat chest X-ray foreign worker.
examination • Perform chest X-ray
5 examination and prepare 40 - 40
(Only for non- chest X-ray report**
Tuberculosis case) • Review/ submit reports
to FOMEMA.
• Verify history of any drug
consumption
Request for confirmation
• Request lab to perform
test
6 GCMS test on the primary/ 35 310 345
original urine sample.
(Case of opiate positive)
• Review/ submit reports to
FOMEMA.
 TOTAL FEE (RM)
LABORATORY
CLINIC FEE***

FEE (RM)
(RM)
NO. ADDITIONAL TESTS SCOPE OF WORKS

• Verify history of any drug

Request for confirmation consumption
test • Request lab to perform
7 GCMS test on the primary/ 35 255 290
(Case of cannabis original urine sample.
positive) • Review/ submit reports to
FOMEMA.
• Verify history of any drug
Request for confirmation
consumption
test
• Request lab to perform
8 GCMS test on the primary/ 35 500 535
(Case of
original urine sample.
methamphetamine
• Review/ submit reports to
positive)
FOMEMA.
• Verify the identity of the
Repeat test for Serum
foreign worker.
Beta-HCG
• Perform phlebotomy, take
blood sample and request
9 (Only if the initial test 45 35 80
lab for Serum Beta-HCG
result of the primary/
testing.**
original sample is
• Review/ submit reports to
indeterminate)
FOMEMA.
 SCHEDULE 2 – Fees for The Additional Tests by Medical Specialist

TOTAL FEE (RM)

CLINIC FEE***

SPECIALIST

FEE**** (RM)
REPORT
(RM)
ADDITIONAL
NO. SCOPE OF WORKS
TESTS

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
Hypertension report to rule out end
1 35 262 297
(Re- appeal) organ damage and for
fitness for employment.
• Reported by internal
medicine specialist/
family medicine
specialist.
• Submission of the above
report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
Diabetes report to rule out end
2 Mellitus organ damage and for 35 484 519
(Re-appeal) fitness for employment.
• Reported by internal
medicine specialist /
family medicine
specialist/
endocrinologist.
• Submission of the above
report.
 TOTAL FEE (RM)
CLINIC FEE***

SPECIALIST

FEE**** (RM)
REPORT
(RM)
ADDITIONAL
NO. SCOPE OF WORKS
TESTS

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

Heart disease • Specialist assessment
3 (including CTR for fitness for 35 740 775
>55 case) employment including
Echocardiogram
(ECHO) report.
• Reported by
cardiologist.
• Submission of the
above report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
4 Urine albumin report to rule out end 298 333
35
(Re-appeal) organ damage and for
fitness for employment.
• Reported by internal
medicine specialist/
nephrologist/ urologist.
• Submission of the above
report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
5 Skin disease for fitness for 35 700 735
(Leprosy) employment including
slit-skin / skin bi ops ytest
report.
• Reported by
dermatologist.
• Submission of the
above report.
 TOTAL FEE (RM)
CLINIC FEE***

SPECIALIST

FEE**** (RM)
REPORT
(RM)
ADDITIONAL
NO. SCOPE OF WORKS
TESTS

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
for fitness for
Goitre/ Thyroid employment including
6 35 461 496
abnormalities Thyroid Function Test
(TFT) lab report.
• Reported by internal
medicine specialist/
endocrinologist/ general
surgeon/ Endocrine &
Breast Surgeon.
• Submission of the above
report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
7 Vision test 35
for 408 443
abnormal fitness for
employment.
• Reported by
Ophthalmologist.
Submission of the
above report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

8 Anaemia/ pallor • Specialist assessment 35 495 530
for fitness for
employment.
• Reported by internal
medicine specialist.
• Submission of the above
report.
 TOTAL FEE (RM)
CLINIC FEE***

SPECIALIST

FEE**** (RM)
REPORT
(RM)
ADDITIONAL
NO. SCOPE OF WORKS
TESTS

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Defective Role of medical specialist:

9 hearing/ • Specialist assessment 35 415
380
deafness report for fitness for
employment.
• Reported by ENT
specialist.
• Submission of the above
report.
Role of Registered Doctor:
• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
10 Bronchial report for fitness for 35
asthma employment. 396 431
• Reported by internal
medicine specialist/
respiratory medicine
specialist.
• Submission of the above
report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
11 Peptic ulcer report for fitness for 35 633 668
employment.
• Reported by internal
medicine specialist/
gastroenterologist/
general surgeon.
• Submission of the above
report.
 TOTAL FEE (RM)
CLINIC FEE***

SPECIALIST

FEE**** (RM)
REPORT
(RM)
ADDITIONAL
NO. SCOPE OF WORKS
TESTS

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Psychiatry Role of medical specialist:

293
12
disorder • Specialist assessment 35 328
report for fitness for
employment.
• Reported by psychiatrist.
• Submission of the above
report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
35 1680 1,715
13 Epilepsy report for fitness for
employment.
• Reported by internal
medicine specialist/
neurologist.
• Submission of the above
report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Breast Role of medical specialist:

abnormalities/ • Specialist assessment
14 report for fitness for 35
swelling/ lump/ 693 728
mass employment.
• Reported by general
surgeon/ endocrine and
breast surgeon.
• Submission of the above
report.
 TOTAL FEE (RM)
CLINIC FEE***

SPECIALIST

FEE**** (RM)
REPORT
(RM)
ADDITIONAL
NO. SCOPE OF WORKS
TESTS

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Limb Role of medical specialist:

abnormalities/ • Specialist assessment 434
15 35 469
scoliosis/ report for fitness for
kyphosis employment.
• Reported by orthopaedic
surgeon.
• Submission of the above
report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

604
16 Cancer/ mass • Specialist assessment 35 639
report for fitness for
employment.
• Reported by oncologist.
• Submission of the above
report.
a) Abnormal X-ray with sign
of Tuberculosis infection;

Role of Registered Doctor:

• Referral letter for
specialist assessment
report.

Role of medical specialist:

• Specialist assessment
report for fitness for 35 1055 1,090
17 employment including TB
Quantiferon and
Abnormal chest GeneXpert lab report.
X-ray • Reported by respiratory
specialist.
(Only for case • Submission of the above
of abnormal report.
chest X-ray
without medical
history of
 TOTAL FEE (RM)
CLINIC FEE***

SPECIALIST

FEE**** (RM)
REPORT
(RM)
ADDITIONAL
NO. SCOPE OF WORKS
TESTS

Tuberculosis b) Abnormal X-ray due to

infection/ non-Tuberculosis infection;
treatment)
Role of Registered Doctor:
• Referral letter for
specialist assessment
report.

Role of medical specialist: 35 1055 1,090

• Specialist assessment
report for fitness for
employment.
• Reported by internal
medicine specialist.
• Submission of the above
report.

Role of Registered Doctor:

• Referral letter for
specialist assessment
Repeat test of report.
Serum B-HCG
positive Role of medical specialist:
18 • Specialist assessment 35 330 365
Only for case report for fitness for
of “not- employment.
pregnant” • Reported by Obstetrics &
condition Gynaecology specialist.
• Submission of the above
report.
 Attachment 3

List of Appeal Panel Hospital

No. Name of Hospital

1. Columbia Asia Tebrau (Johor)
2. Putra Specialist Hospital (Melaka)
3. Aurelius Hospital Nilai (Negeri Sembilan)
4. KPJ Sentosa (Kuala Lumpur)
5. KPJ Ipoh Specialist Hospital (Perak)
6. Kedah Medical Center (Kedah)
7. KPJ Penang (Penang)
8. KPJ Perlis Specialist Hospital (Perlis)
9. KPJ Perdana (Kelantan)
10. IMSC (IIUM Medical Specialist Center) (Pahang)
11. KPJ Sabah Specialist Hospital
 Attachment 4

APPEAL REFERRAL LETTER FOR SPECIALIST ASSESSMENT REPORT

To Consultant / Specialist (FOMEMA Appeal Panel)

Name of Panel Hospital

Date of Referral

This FOMEMA appeal case is referred for your assessment in regard to evaluation of any end organ
damage and to determine the fitness for employment. The details of the case as below:

Particulars of Foreign Worker

Name of Foreign Worker

Passport No. /
FOMEMA Worker Code

Case Summary

• Date of FOMEMA medical

examination

• Reason for unsuitability

(why failed FOMEMA test)

• Key findings during

FOMEMA medical
examination

• Latest laboratory test

results (if applicable)

• Current Diagnosis

Information of Referring Doctor

Name of Doctor

Contact No.

Clinic Name Signature of Doctor & Official Stamp