Prosedur Pemeriksaan Perubatan

(Untuk Perhatian Majikan)

1. Sila pastikan semua maklumat di Borang Pemeriksaan Perubatan ini adalah tepat.
2. Tempoh sah laku Borang Pemeriksaan Perubatan adalah 30 hari dari tarikh pendaftaran.
3. Majikan perlu melengkapkan pemeriksaan kesihatan dalam tempoh tujuh (7) hari bekerja dari tarikh mereka tiba di klinik.
4. Sebarang permohonan pembatalan pendaftaran dan tuntutan bayaran balik hanya dibenarkan dalam tempoh sah laku
Borang Pemeriksaan Perubatan; tertakluk kepada yuran perkhidmatan sebanyak RM27.00 bagi setiap pekerja asing.
5. Sila pastikan Borang Pemeriksaan Perubatan ini dibawa bersama pasport asal untuk pemeriksaan perubatan dan X-ray.
Pihak FOMEMA hanya membenarkan panel doktor dan pusat X-ray untuk menjalankan pemeriksaan perubatan dan X-ray
sekiranya pengesahan identiti Pekerja Asing dilakukan dengan pasport asal.
6. FOMEMA tidak bertanggungjawab ke atas pembayaran sekiranya pemeriksaan perubatan dijalankan oleh klinik selain
daripada yang tercatat dalam borang ini.
7. Pekerja asing dikehendaki menjalani pemeriksaan perubatan oleh doktor terlebih dahulu sebelum menjalankan
pemeriksaan X-ray.
8. Sila pastikan tarikh pemeriksaan doktor telah diisi oleh doktor di dalam borang ini selepas pemeriksaan perubatan
dijalankan.
9. Majikan juga perlu menyimpan keratan "Salinan Majikan" sebagai rujukan.
10. Status keputusan pemeriksaan perubatan pekerja boleh disemak dalam masa 7 hari bekerja dari tarikh pemeriksaan
perubatan dijalankan oleh doktor melalui Portal FOMEMA: https://portal.fomema.my
11. Rekod keputusan pemeriksaan perubatan pekerja asing akan dihantar ke Jabatan Imigresen Malaysia setelah proses
perubatan selesai.
12. Status keputusan pemeriksaan perubatan pekerja asing FOMEMA di Jabatan Imigresen Malaysia hanya sah selama 180
hari dari tarikh pemeriksaan perubatan dijalankan.

Medical Examination Procedure

(For Employer's Attention)
1. Please ensure that all information on this Medical Examination Form is accurate.
2. The validity period of the Medical Examination Form is 30 days from the date of registration.
3. Employer must complete medical examination within seven (7) working days from the date of their arrival at the clinic.
4. Any request for cancellation of registration and refund request is only allowed within the validity period of the Medical
Examination Form; will be subjected to a service fee of RM27.00 for each worker.
5. Please ensure that this Medical Examination Form is brought together with the original passport of the foreign worker for
medical examination. FOMEMA only allows registered panel doctors and X-ray centers to conduct medical examinations
and X-ray after verification of the identity of the foreign worker is done with the original passport.
6. FOMEMA will not be responsible for any payment if the medical examination is carried out by medical facilities other than
named below.
7. The foreign worker must undergo the physical examination by the doctor before undergoing the X-ray examination
8. Please ensure that the date of the medical examination is duly filled by the doctor in this form after the physical examination
has been completed.
9. The employers should retain the "Employer's Copy" of this form as reference
10. The status of medical examination result can be obtained within 7 working days from the date of the medical examination
by the doctor through FOMEMA Online Portal: https://portal.fomema.my
11. The result of the foreign worker's medical examination will be transmitted to the Immigration Department of Malaysia once
completed
12. The status of FOMEMA foreign worker medical examination results at the Immigration Department of Malaysia is only valid
for 180 days from the date of medical examination was carried out.

Document : FM-MEF-OPS Page: 1/2

Revision / Date : 02/06-23
 BORANG PEMERIKSAAN PERUBATAN Tarikh Pemeriksaan :
Examination Date
MEDICAL EXAMINATION FORM
Tandatangan Doktor :
Doctor's Signature

Sah Sehingga/ Valid Until: 02/04/2024 Cop Klinik :

Cancellation/ Refund before 02/04/2024 Clinic's Stamp

Kod Pekerja: W3EF053399

Worker Code
Nama Pekerja: FERUZ ALAM Tarikh Pendaftaran: 04-03-2024
Worker Name Date of Registration
3 NEW TESTS
No. Pasport: EH0798427 Nama Majikan: CHEMCASTLE SDN. BHD.
Passport No. Employer Name
Negara: BANGLADESH Kod Majikan: E7EC030438
Country Employer Code
Jantina: MALE No. Telefon Doktor: 0397677996
Gender Doctor Telephone No.
Tarikh Lahir: 10-06-1980 No. Telefon X-Ray: 0340412611
Date of Birth X-Ray Telephone No.

Sah Sehingga/ Valid Until: 02/04/2024 3 NEW TESTS

Kod Doktor: D94W000027 ID Trans: 20240304774777
Doctor's Code Trans ID
Nama Doktor: WIDYADASHINI A/P KASHINATHAN Kod Pekerja: W3EF053399
Doctor Name Worker Code
Nama Klinik & KLINIK PUTRIMEDIK Nama Pekerja: FERUZ ALAM
Alamat: B-0-10, VIVA RESIDENCY Worker Name
Clinic Name & JALAN SUPPIAH PILLAY
No. Pasport: EH0798427
Address 51200 JLN IPOH KUALA LUMPUR
Passport No.
Jantina: MALE
Gender
Tandatangan Doktor :
Doctor's Signature
Cop Klinik : Tarikh Pemeriksaan: No. Telefon Majikan : 016286966
Clinic's Stamp Examination Date Employer Contact No.

Sah Sehingga/ Valid Until: 02/04/2024 3 NEW TESTS

Kod Makmal: L24P000010 Kod Doktor: D94W000027
Laboratory's Code Doctor's Code
No Telefon: 0362436367 No Telefon: 0397677996
Telephone No. Telephone No. ID Trans: 20240304774777
Nama Makmal & PRIMA LAB SDN BHD Nama Klinik & KLINIK PUTRIMEDIK Trans ID
Alamat: NO.12-1, JALAN 3/42A Alamat: B-0-10, VIVA RESIDENCY Kod Perkerja: W3EF053399
Laboratory's TAMAN SEJAHTERA Clinic Name & JALAN SUPPIAH PILLAY Worker's Code
Name & Address 51200 KL KUALA LUMPUR Address 51200 JLN IPOH KUALA
Nama Pekerja: FERUZ ALAM
LUMPUR
Worker's Name

No. Passport: EH0798427

Passport No.
Tandatangan Doktor : Jantina: MALE
Doctor's Signature Gender
Cop Klinik : Tarikh Pemeriksaan:
Clinic's Stamp Examination Date

Sah Sehingga/ Valid Until: 02/04/2024

Kod X-Ray: X94K000136 Kod Doktor: D94W000027

X-Ray's Code Doctor's Code
No. Telefon: 0340412611 No Telefon: 0397677996
Telephone No. Telephone No. ID Trans: 20240304774777
Nama Fasiliti KLINIK REDDY (JALAN IPOH) Nama Klinik KLINIK PUTRIMEDIK Trans ID
X-Ray & Alamat: 121, JALAN IPOH & Alamat: B-0-10, VIVA RESIDENCY Kod Pekerja: W3EF053399
X-Ray's Facility 51200 KL KUALA LUMPUR Clinic Name JALAN SUPPIAH PILLAY Worker's Code
Name & & Address 51200 JLN IPOH KUALA
LUMPUR Nama Pekerja: FERUZ ALAM
Address Worker's Name

No. Pasport EH0798427

Passport No.
Tandatangan Doktor : Jantina: MALE
Doctor's Signature Gender
Cop Klinik : Tarikh Pemeriksaan: No. Telefon Majikan: 016286966
Clinic's Stamp Examination Date Employer Contact No.
Page: 2/2