Medical Claim Form Medical Claim Form 醫療索償表 Staff ID*員工編號 X-XXXXFull Name (English)*全名（英文）Email Address* 電子郵件地址 Department* 部門Please select an optionAdministrationFinance & ComplianceGroup WholesaleHuman ResourcesInformation TechnologyPublic Relations & MarketingShowroomSQWarehouseTreatment Details診治詳情Treatment Date*診治日期 Date Format: DD slash MM slash YYYY Claim Item*索賠項目Please select an option普通科/General Practitioner專科/Specialist影像診斷 化驗Diag. Imaging & Lab Tests中醫/Chinese Herbalist跌打/Bonesetter物理治療/Physiotherapist脊醫/ChiropractorReceipt Amount HKD* 收據金額 HKDUpload Supporting Documents上載證明文件Payment Receipt*付款收據 Max File Size: 4MB Drop files here or Accepted file types: pdf, jpg, jpeg, bmp. Remark備註
