GP REFERRAL FORMSELECT SPECIALITYANAESTHESIOLOGYPEDIATRICSGENERAL SURGERYINTERNAL MEDICINEOBSTECTRICS & GYNAECOLOGYORTHOPEDICS & TRAUMATOLOGYOTORHINOLARYNGOLOGY (EAR, NOSE & THROAT)UROLOGYRADIOLOGYPHYSIOTHERAPY SERVICEBREAST & ENDOCRINEDIETITIANSELECT DOCTORDR. AHMAD SABRI BIN SHARIFDR. MOHD HANIF BIN CHE MATSELECT DOCTORDR. CHE SUHAIDA BINTI CHE DIRDR. LIM CHOON HAIDR. MOHD HAZMAN BIN KAMARUZAMANSELECT DOCTORDATO’ DR ABD JAMIL BIN ABDULLAHDR. MUHAMMAD RUSDI BIN ABDUL RAHMANDR NIK MOHD NURHAFIZI NIK ANUARDR. RUSLI BIN ABDULLAHSELECT DOCTORDR. MOHD AIZUDDIN BIN YUSOFSELECT DOCTORDR. FAIZAN IRDAWATY BINTI ENDUTDR. MOHD NASIR BIN TAK ABDULLAHDR. SHENG KUN LENGDR. ROHANA BINTI ISMAILSELECT DOCTORDR. MUHAMAD AIZAT BIN MOHAMED SAATDR. ZAHARUL AZRI BIN MUSTAPHA @ ZAKARIASELECT DOCTORDR. MOHD IRMAN SHAH BIN IBRAHIMDR. MOHD ZUL IZZI BIN FAUZISELECT DOCTORDATO’ DR ABD JAMIL BIN ABDULLAHDR NIK MOHD NURHAFIZI NIK ANUARSELECT DOCTORDR. CHEAH WAI HUNSELECT DOCTORMUHAMMAD ZULFAHMI BIN MOHDDR SOPIAN BIN ABDUL WAHABDR. MUHAMMAD IZZAD BIN JOHARIDR. NUR RAZIANA BINTI ROZISELECT DOCTORDR. WAN HASMAH BINTI WAN JUSOHSELECT DOCTORNORAZMAN BIN AJISSELECT DOCTORNURSYAHIRAH BINTI KAMARUDDINSELECT DOCTORPUAN FATIN SAHIRA BINTI AHMAD ZULKIFLIFROMGP DOCTORS NAME *CLINIC NAME *CLINIC LOCATION *CLINIC'S EMAILPATIENT'S NAME *PATIENT'S NRIC/PASSPORT NO. *PATIENT'S EMAILPATIENT'S PHONE NUMBER *CLINICAL HISTORY AND PHYSICAL FINDINGSChoose FileNo file chosenDelete uploaded fileRESULTS OF PROCEDURES / INVESTIGATIONS PERFORMEDChoose FileNo file chosenDelete uploaded fileREMARKS / OTHERS / FURTHER INVESTIGATION(S) REQUEST (E.G., CXR, MRI, CT, ETC)PATIENT'S MODE OF PAYMENT *SELECT PAYMENTSELF-PAYINSURANCE/ TPABILL TO CLINICCONSENT *I hereby allow my personal data to be processed for purposes stated in SALAM Kuala Terengganu Specialist Hospital Privacy Policy.SUBMIT