KPJ MIRI SPECIALIST HOSPITAL ONLINE DECLARATION FORM FOR COVID19 SCREENING APPOINTMENT
As part of public risk preventive measures, we seek your cooperation to provide the following information on this Online Declaration Form for the safety of all occupants/visitors in the building and for contact tracing purposes. Thank you for your time and understanding.
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Please take note that / Sila ambil perhatian:
Covid19 PCR:
Acceptable for general purposes e.g. self evaluation, travel, screening, etc. (Result will be ready in 3 days)
Boleh diterima untuk tujuan umum seperti penilaian diri, perjalanan, pemeriksaan, dll. (Keputusan akan keluar dalam masa 3 hari)

RTK Antigen:
Acceptable for self-evaluation, travelling to Sabah/Labuan, company screening (Please consult relevant authority prior to travel using this test). Result will be ready in the same day.
Boleh diterima untuk penilaian diri, melakukan perjalanan ke Sabah / Labuan, pemeriksaan syarikat (Sila dapatkan nasihat pihak berkuasa sebelum melakukan perjalanan menggunakan ujian ini). Keputusan akan keluar pada hari yang sama.

RTK Antigen PERKESO:
For Foreign Workers ONLY, require PERKESO number.
HANYA Untuk Pekerja Asing, memerlukan nombor PERKESO.

KPJ MIRI SPECIALIST HOSPITAL (MON - SAT 0800-1030)
PCR - RM230
RTK - RM100
ID NOW - RM320
IPONETIC - RM300

ONSITE/AFTER HOUR/SUNDAY/PH
PCR - RM300
RTK - RM150

PRE ADMISSION
RTK - RM60
ID NOW - RM260
RESPIRATORY PANEL - RM550
Please choose *
Sila Pilih
Full Name *
Nama Penuh Seperti Di Dalam IC / Paspot
New IC Number / Passport Number *
Nombor IC / Paspot
Date of Birth *
Tarikh Lahir
MM
/
DD
/
YYYY
Age *
Umur
Gender *
Jantina
Home Address *
Alamat Rumah
Home Contact Number
Nombor Telefon Rumah (jika ada)
Mobile Number *
Nombor Telefon Bimbit
Email Address *
Please provide a valid email address, we will send your appointment confirmation slip to this email. Sila berikan alamat email yang betul, kami akan menghantar slip pengesahan temujanji anda ke email ini.
Company Name / Office Address *
Nama syarikat / Alamat pejabat
Appointment Date *
When are you planning to do the Covid19 Screening? Swab Test is available from Monday to Saturday from 8AM - 11AM. No swab test on Sundays and Public Holidays. Bilakah anda merancang untuk melakukan Pemeriksaan Covid19? Ujian Swab hanya diadakan dari Isnin hingga Sabtu dari jam 8:00 pagi - 11:00 pagi. Tiada ujian swab pada hari Ahad dan Cuti Umum.
MM
/
DD
/
YYYY
How would you like to receive your Covid19 Swab Test result? *
Bagaimana anda mahu menerima keputusan Ujian Swab Covid19 anda?
Mode of Payment *
If you are using GL, kindly make sure your Company GL Person in Charge contact our Marketing Team ahead of your appointment to save time. If you are paying and claiming from your company, it is considered Self Paying. Jika anda memilih GL, pastikan syarikat anda telah menghubungi Marketing Team kami sebelum temujanji anda untuk menjimatkan masa menunggu. Sekiranya anda membayar dan membuat tuntutan dari syarikat anda, ia dianggap Bayaran Sendiri (Self Paying).
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