What is a Surat Keterangan Dokter Form?
A Surat Dokter Form typically translates to a Special Doctor Form. It is a special form or a medical certificate for cancer.
The form is filled specifically for Sequis lady protection rider claims. It is an insurance product where women insure a sum for a critical illness. The claim is generally settled by the company paying the full insured amount or by paying for the surgery in full.
The form is filled by the doctor who is treating the concerned patient and is directly sent to the company’s office.
Information required on a Surat Keterangan Dokter Form
Since the form is being filled in order to claim the insurance, essentially every information related to the patient’s diagnosis will have to be mentioned in detail.
- Name of the Patient
- Personal details of the Patient such as Age, Gender, Address, Occupation, and so on
- Disease/ Cancer Diagnosis
- Date of Diagnosis
- How Was It Classified
- Reports From the Doctor
- Special Details to be Known by the Company, If Any
How to Fill Out a Surat Keterangan Dokter Form?
Obtain the Surat Keterangan Dokter form from authorized sources. It could be online as well as offline. You can pick up the form in person from the hospital. You can also skip the queues and the crowd by downloading and printing the form online from any authorized website. Filling the form online takes less time and helps prevent mistakes.
- Start by filling out the patient’s personal details such as their name, age, gender, occupation, and address.
- In the next section, there will be questions asking details about the kind of cancer, the date that it was diagnosed and the treatment required.
- If it has spread to the lymph nodes and metastases have occurred, mention that.
- Move on to the next part that specifies a few other conditions and asks if the patient has been suffering from those along with the primary disease. Check all that is correct.
- Mention the patient’s anatomical pathology results including both micro and macroscopic.
- In the next question, answer when the first symptoms of the disease were felt by the patient.
- If the patient has had any actions or surgeries performed, mention their details and when they were performed.
- If other therapies are needed in addition to surgical procedures, specify the therapy and its type detail.
- The form also asks about the patient’s prognosis and life expectancy.
- Mention if the patient is a referral from a doctor or other hospital. Mention the doctor’s or hospital’s details.
- If there is any other information that needs to be known by the insurance company, mention that in detail.
- Please note that the claim will only be expedited if the doctor attaches the relevant medical reports, anatomical pathology results, laboratory results, and other examinations that support the diagnosis of the disease above.
- To end the form, write the date and place where the form is filled. And the name, signature, and the stamp of the doctor’s facility.
It is always suggested that you keep a copy of the Surat Dokter Form for yourself.
What is the Surat Keterangan Dokter Form Used for?
The Surat Keterangan Dokter form is filled by the doctor of the patient who is claiming the insurance amount against the diagnosed cancer. It is for the insurance company to review the details filled by the applicant and verify them before releasing the amount.
The form could have legal implications and it should always have the correct information on it. Therefore, cautiousness while filling it out is advised.
