Certificate of Health for Tuberculosis Screening
Certificate of Health
(Photo) 3㎝×4㎝
Name Sex
□ M □ F
Date of Birth Phone Number
Passport Number Address
Physical examination and Chest X-ray or * (type of TB test) Height
cm
Weight
kg
Blood Pressure
/ mm Hg Date of Chest X-ray or * : / /
(type of TB test) day month year I. (1) Result:
1. Non-specific □ 2. Inactive TB □ 3. Active TB □
→ 3-1. Infective □ Non-infective □
→ 3-2. Drug-sensitive TB □ MDR TB □
II. (2) Treatment Outcomes - For person who has TB history
1. Under treatment □ 4. Failed □
2. Cured □ 5. Defaulted □
3. Completed Treatment □
The examination was performed as above.
License No.: Name of Physician: ( Signature )
Summary of the examination Remarks about examinee’s stay in Korea
Additional close examination
* Attach doctor's opinion letter, if needed We hereby certify that the examinee's health status is assessed as above.
Date: Official stamp:
( Hospital )
Requirement for Tuberculosis (TB) Test Certificate Submission
High TB-burden countries:
Nepal Timor Leste Russia Malaysia Mongolia Myanmar
Bangladesh Vietnam Sri Lanka Uzbekistan India Indonesia China Cambodia Kyrgyzstan Thailand Pakistan Philippines Laos Kazakhstan Tajikistan Ukraine Azerbaijan Belarus Moldova Nigeria South Africa Ethiopia Congo Kenya Mozambique Zimbabwe Angola Peru Papua New Guinea Legal Basis
Articles 11, 46(1), and 89(1) of the Immigration Act
Article 9-2 of the Enforcement Decree of the Immigration Act
Articles 2, 41, and 42 of the Infectious Disease Control and Prevention Act Article 24 of the Quarantine Act
Article 15 of the Tuberculosis Prevention Act Applicable to
National of high TB-burden countries who apply for long-term visa at the Embassy of the Republic of Korea in Malaysia
- including all D-type and F-type visas
- including applicants who have received the Certificate of Confirmation of Visa Issuance, or the Visa Issuance Confirmation Number
Exemption
The following are exempted from this requirement:
- diplomatic and official passport holders applying for Diplomat (A-1), Foreign Government Official (A-2), or International Agreement (A-3) visas
- children below 6 years old - pregnant mother-to-be
(with pregnancy certificate issued within 1 month by a physician) Required Documents
During submission of visa application, applicant must submit along the following documents issued within 3 months from one of the designated hospitals in Malaysia:
- Certificate of Health
- Chest x-ray report / radiology report [Note] TB tests other than chest x-ray*
If for some reason the applicant cannot undergo a chest x-ray test, please ask the physician to state the type of alternative TB tests conducted (sputum test, tuberculin skin test, or blood test) in the Certificate of Health, and to attach the report of the alternative TB test result.
List of Designated Hospitals in Malaysia for TB Screening
No. Name and address Contact details State
1.
Gleneagles Hospital (Kuala Lumpur) 282 and 286, Jalan Ampang,
50450 Kuala Lumpur
03-41413282
Kuala Lumpur 2.
Tung Shin Hospital No. 102, Jalan Pudu, 55100 Kuala Lumpur
03-20372288
3.
Assunta Hospital Jalan Templer,
46990 Petaling Jaya, Selangor
Dr. I Kuppusamy 03-78723000 ext. 3015
Selangor 4.
KPJ Ampang Puteri Specialist Hospital No. 1, Jalan Mamanda 9,
Taman Dato’ Ahmad Razali, 68000 Ampang, Selangor
03-42895000
5.
Sunway Medical Centre No. 5, Jalan Lagoon Selatan, Bandar Sunway,
47500 Selangor
03-74911198 03-74911302
6.
Kempas Medical Centre
Lot PTD 7522, Jalan Kempas Baru, 81200 Johor Bahru, Johor
07-2368899 Johor
7.
Putra Medical Centre
888, Jalan Sekerat, Off Jalan Putra, 05100 Alor Setar, Kedah
04-7342888 Kedah
8.
Pantai Hospital Ayer Keroh
No. 2418-1 KM8, Lebuh Ayer Keroh, 75450 Melaka
06-2319999 Melaka
9.
KPJ Penang Specialist Hospital
570, Jalan Perda Utama, Bandar Perda, 14000 Bukit Mertajam, Pulau Pinang
04-5486688
Pulau Pinang 10.
Pantai Hospital Penang 82 Jalan Tengah, Bayan Baru, 11900 Bayan Lepas, Pulau Pinang
04-6433888
11.
Penang Adventist Hospital 465 Jalan Burma,
10350 Pulau Pinang
04-2227779 04-2227732
12.
KPJ Sabah Specialist Hospital Lot No. 2, Off Jalan Damai, Luyang, 88300 Kota Kinabalu, Sabah
088-322000
088-322196 Sabah
13.
Columbia Asia Hospital – Miri
Lot 1035-1039, Jalan Bulan Sabit, CDT 155, 98009 Miri, Sarawak
085-437755 085-405600
Sarawak 14.
KPJ Kuching Specialist Hospital
Lot 10420, Block 11, Tabuan Stutong Commercial Centre, Jalan Setia Raja, 93350 Kuching, Sarawak
082-365777
15.
Normah Medical Specialist Centre
Lot 937, Section 30, KTLD, Jalan Tun Abdul Rahman Yakub, Petra Jaya, 93050 Kuching, Sarawak
082-440055
16.
Timberland Medical Centre
Lot 5164-5165, Block 16, KCLD 2 ½ Mile, Rock Road Taman Timberland, 93250 Kuching, Sarawak
082-234466
