Medical Record Service Center

Medical Record Privacy Conditions

You must agree to the following conditions to request the Medical Records. Click on one of the four topics below for more information:

I am requesting these medical records for:
* Myself
My Email:

The medical records request form will appear after you have selected “I agree” above
Patient First Name * Patient Last Name * Date of Birth * Hospital Number *

Street Address *

City * State * Zipcode *  

Phone * Email address *    

Medical Record Details:

     Insurance File:  

     to as
How would you like to receive the medical records :
(Please bring patient's ID/passport and authorization letter)
E-mail address:
Medical Record Cost
1-50 pages 100 baht
> 50 pages 200 baht each
CD-ROM 200 baht each

These prices do not include any applicable delivery charges.

We will send the online payment details to your email. Which email should we send this to?

If you are not picking up the medical records in person, you must upload the following files:
Attach a copy of patient's passport (.jpg, .pdf, .doc, .docx – less than 10 MB in size):
Attach authorization letter or birth certificate (.jpg, .pdf, .doc, .docx – less than 10 MB in size):

Requests with incomplete documentation will not be processed. Please ensure you have all of the required documentation.