IIUMSC & LPPKN Patient Validation Form

IIUMSC Patient Information Registration Form

Maklumat Pesakit / Patient Information

Sila isi semua butiran peribadi anda.

Kindly fill up all your details.

Maklumat Waris / Next of Kin Information

Sila isi maklumat di bawah. Anda boleh mengisi maklumat pasangan atau ahli keluarga terdekat.

Please fill up the information below. You can give your spouse or closest family members details.