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Dear Doctor, INVITATION TO JOIN THE “GP AFFILIATION PROGRAMME” Warmest greetings from Sri Kota Specialist Medical Centre Klang. It is my pleasure to invite you to join the “Sri Kota GP Affiliation Programme”. They key objectives of this programme are: To enhance communication between General Practitioners and Sri Kota’s Consultant’s Specialist, Management and other team members. To provide an integrated patient care services To thank all family Practitioners who have been supporting Sri Kota for the past years Medical Director Tel No: 03-3373 3636 Ext 7310 Assisted by our Marketing team: Tel No Mr. Gan Kah Long Mr. Rubinderjit Singh JS Ms. Jenny Wang Ms. Sharmaine Joan Biggs Ms. Nur Syafiqah Mohd Ghazali Ms. Etau Rabung 03-3373 3636 Ext Head of Marketing Department Asst. Marketing Manager Asst. Manager – Strategic Partnering Marketing Executive Sr. Marketing Officer Marketing Officer 7308 7356 7335 7313 7313 7313 We welcome you and thank you for joining the GP Affiliation Programme Yours sincerely, Dr.Sadasivam Kandiah Medical Director Cc: Madam Tan Suet Guan - CEO MKT3/GP Affiliation/2015 GP AFFILIATION PROGRAMME PERSONAL DATA Name (according to I/C underline surname) Correspondence Address: Contact No : (O): ____________________ (H): ___________________ (H/P):___________________ Date of Birth : ____________________________ NRIC No Religion : ___________________________ : Muslim Buddhist Marital Status : Single Married Others Ethnic Group : Malay Chinese Indian Place of Birth : ________________________ Gender Christian : ________________________ Hindu Others Others: ______________ SPOUSE DATA Spouse’s name (according to I/C underline surname): Correspondence Address: Contact No :(O): ____________________ (H): ___________________ (H/P): ___________________ Date of Birth : __________________________ Place of Birth : _________________________ NRIC No : __________________________ Gender : _________________________ Religion : Muslim Buddhist Christian Hindu Ethnic Group : Malay Chinese Indian Others: MKT3/GP Affiliation/2015 Others ______________ 1. Child’s Name (according to I/C underline surname): Date of Birth : __________________________ Place of Birth : ____________________________ NRIC No : __________________________ Gender : ____________________________ 2. Child’s Name (according to I/C underline surname): Date of Birth : __________________________ Place of Birth : ____________________________ NRIC No : __________________________ Gender : ____________________________ 3. Child’s Name (according to I/C underline surname): Date of Birth : __________________________ Place of Birth : ____________________________ NRIC No : __________________________ Gender : ____________________________ 4. Child’s Name (according to I/C underline surname): Date of Birth : __________________________ NRIC No : __________________________ Gender MKT3/GP Affiliation/2015 Place of Birth : ____________________________ : ____________________________ SRI KOTA SPECIALIST MEDICAL CENTRE GENERAL PRACTITIONERS (GP) AFFILIATION PROGRAMME YOU BENEFITS AS AN AFFILIATE GP (a) Conferring privileges, where you will be able to visit your patients when they are admitted to Sri Kota and can be provided to access to their current medical notes with treating consultant. (b) Participation in Sri Kota’s continuing Medical Education Programmes. (c) Hospitalization benefits for yourself, your spouses and children (in full time education and under 23 years old) Discount on Room & Board Room Type Discount off Published Rates 4 Bedded 2 Bedded Single Bedded Single Suite 10% 25% 25% 25% 10% on outpatient treatment 7% discount on Hospital charges Free admission to Sri Kota Patient and Public Education Talks. Discount at Sri Kota cafeteria (staff price) Page 1 MKT3/GP Affiliation/2015 SRI KOTA SPECIALIST MEDICAL CENTRE GENERAL PRACTITIONERS (GP) AFFILIATION PROGRAMME HOW TO USE YOUR BENEFITS As an Affiliate GP, you will receive an identification card that will ensure you receive your benefits in the Hospital. Please review the procedures outlined below to ensure you fully enjoy your Affiliation with Sri Kota CONFERRING PRIVILEGES Please present your identification card to the Nurse-in-charge of the Unit ADMISSION Have either you or a member of your family present the identification card to the Admission staff. Page 2 Page 2 MKT3/GP Affiliation/2015 SRI KOTA SPECIALIST MEDICAL CENTRE GENERAL PRACTITIONERS (GP) AFFILIATION PROGRAMME As a part of Sri Kota Specialist Medical Centre GP Affiliation Programme, Sri Kota is pleased to introduce “Conferring Privileges” and extend these privileges to general practitioners who are members of the Affiliate GP Programme. “Conferring Privileges” provide for the following features concerning patients referred by you to SKSMC for those who present their Sri Kota Affiliate GP Identification card at the Nurse Station: 1. To be briefed on the patient’s condition by the Nurse in-charge of the unit, at the time of the visit 2. Encouraged to confer with the consultant regarding the patient’s course of treatment when you feel useful information and observations will be beneficial (such as a family history of diabetes, prior existing condition not evident, etc.) 3. Pursuant to the above, Affiliate GPs are encouraged to visit the patient and confer with them and / or their relative, regarding the course of their treatment in the Hospital or their concern. “Conferring Privileges” do not provide for and does not allow for the following: a. Orders for patient investigations, treatment and /or medications b. Notes in the patients medical record c. Sri Kota patient billing for these visits Page 3 Page 2 MKT3/GP Affiliation/2015 SRI KOTA SPECIALIST MEDICAL CENTRE GENERAL PRACTITIONERS (GP) AFFILIATION PROGRAMME The intent of “Conferring Privileges” for the Affiliate GP is to provide a forum for access to patient’s records, nurses and consultant for general practitioners who have referred patients to Sri Kota. This is to enhance the General Practitioners relations with the patients while they are inpatients in Sri Kota; and to aid the continuity of patient care, once they are discharged and return to the care the general practitioners. To above provisions are intended to achieve these objectives. However, whenever an Affiliate GP or an Attending Consultant has a question as to how these provisions apply to a particular patient, or other question concerning these privileges, they should contact the Marketing Department and Madam Tan Suet Guan (Chief Executive Officer) or Dr.Sadasivam Kandiah, Medical Director of Sri Kota Specialist Medical Centre. Sri Kota retains the exclusive right to alter or restrict consulting privileges at any time when it deems to be the best interest of the patient to do so. Page 4 MKT3/GP Affiliation/2015