Hospital Services / Prior Approvals

Dear Hospital Service Providers,
Please be aware complete the missing details as in beneficiary card.
Please complete the data missing for English Only.
All attached downloads must be Original and Clear.
Sincerely!

Select Action Hospital*

Governorate*

Branch / Area*

Type Of Entry*

Type Of Service*

Type Of Other Service

Name Of Physician's*

Majors*

Date of Service*

Date of Service

Date of End*

Date of End

Cost Estimation Of In-Patient

Service Cost Of Out-Patient

Endurance Ratios*

Beneficiary's Co-payment

Beneficiary's Card*

Beneficiary's National ID*

Physician Prescriptions*

Swagrass Form*

Report Case 1

Report Case 2

Report Case 3

Report Case 4

Report Case 5

Report Case 6

Report Case 7

Report Case 8

Report Case 9

Report Case 10

Beneficiary's Phone Number*

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