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: 19/01/2024 Cop Klinik :

Cancellation/ Refund before 19/01/2024 Clinic's Stamp

Kod Pekerja: W21Y047459

Worker Code
Nama Pekerja: YULIDAR Tarikh Pendaftaran: 21-12-2023
Worker Name Date of Registration
3 NEW TESTS
No. Pasport: C5717978 Nama Majikan: MADOS'S HOLDINGS SDN BHD
Passport No. Employer Name
Negara: INDONESIA Kod Majikan: E71M009532
Country Employer Code
Jantina: FEMALE No. Telefon Doktor: 078916700
Gender Doctor Telephone No.
Tarikh Lahir: 23-07-1969 No. Telefon X-Ray: 078831944
Date of Birth X-Ray Telephone No.

Sah Sehingga/ Valid Until: 19/01/2024 3 NEW TESTS

Kod Doktor: D21M000042 ID Trans: 20231221785040
Doctor's Code Trans ID
Nama Doktor: MASLINDA BINTI MD SHARIF Kod Pekerja: W21Y047459
Doctor Name Worker Code
Nama Klinik & POLIKLINIK PENAWAR Nama Pekerja: YULIDAR
Alamat: NO. 2, JALAN DATO USMAN AWANG Worker Name
Clinic Name & TANJUNG SEDILI
No. Pasport: C5717978
Address 81910 KOTA TINGGI JOHOR
Passport No.
Jantina: FEMALE
Gender
Tandatangan Doktor :
Doctor's Signature
Cop Klinik : Tarikh Pemeriksaan: No. Telefon Majikan : 073310888
Clinic's Stamp Examination Date Employer Contact No.

Sah Sehingga/ Valid Until: 19/01/2024 3 NEW TESTS

Kod Makmal: L61N000001 Kod Doktor: D21M000042
Laboratory's Code Doctor's Code
No Telefon: 078822316 No Telefon: 078916700
Telephone No. Telephone No. ID Trans: 20231221785040
Nama Makmal & NORTHERN MEDICAL Nama Klinik & POLIKLINIK PENAWAR Trans ID
Alamat: LABORATORY SDN BHD Alamat: NO. 2, JALAN DATO USMAN Kod Perkerja: W21Y047459
Laboratory's 48, JALAN NIAGA Clinic Name & AWANG Worker's Code
Name & Address 81900 KOTA TINGGI JOHOR Address TANJUNG SEDILI
Nama Pekerja: YULIDAR
81910 KOTA TINGGI JOHOR
Worker's Name

No. Passport: C5717978

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

Sah Sehingga/ Valid Until: 19/01/2024

Kod X-Ray: X31P000047 Kod Doktor: D21M000042

X-Ray's Code Doctor's Code
No. Telefon: 078831944 No Telefon: 078916700
Telephone No. Telephone No. ID Trans: 20231221785040
Nama Fasiliti POLIKLINIK PENAWAR Nama Klinik POLIKLINIK PENAWAR Trans ID
X-Ray & Alamat: NO. 30E, JALAN TUN SRI & Alamat: NO. 2, JALAN DATO USMAN Kod Pekerja: W21Y047459
X-Ray's Facility LANANG Clinic Name AWANG Worker's Code
Name & 81900 KOTA TINGGI JOHOR & Address TANJUNG SEDILI
81910 KOTA TINGGI JOHOR Nama Pekerja: YULIDAR
Address Worker's Name

No. Pasport C5717978

Passport No.
Tandatangan Doktor : Jantina: FEMALE
Doctor's Signature Gender
Cop Klinik : Tarikh Pemeriksaan: No. Telefon Majikan: 073310888
Clinic's Stamp Examination Date Employer Contact No.
Page: 2/2