Purpose and completion
A Singapore-registered doctor supports the patient’s visit-extension request on medical grounds; the patient provides consent to disclose relevant medical information to ICA.
Fields and checks
Prepare the following information as applicable to this form.
| Part | Information |
|---|---|
| Doctor section | Patient name/passport, requested days, medical condition, treatment plan/frequency and next appointment |
| Travel assessment | Fit to travel and whether travel is life-threatening, with reasons |
| Doctor identification | Name, signature, clinic stamp/address, date, phone and MCR number |
| Patient consent | Disclosure consent, signature/thumbprint and date |
Declarations and supporting records
This medical support does not itself extend the visit pass. Submit it with the applicable extension process; the doctor completes medical judgements and the patient’s consent is a separate signed part.
Official ICA source
Written independently from ICA’s English original. The linked source supplies the complete document and subsequent updates.