Samsung Miracle Eye Clinic, Responsible for Your Eye Health
Non-Coverage/Document Issuance
Everything you need to know regarding certificate issuance and non-coverage.
According to Article 21, Paragraph 1 of the Medical Service Act, a patient’s medical records must not be viewed or copies thereof provided to anyone other than the patient, but copies may be issued if Article 21, Paragraph 2 of the Medical Service Act and Article 12, Paragraph 2 of the Enforcement Decree of the Medical Service Act (Requirements for Viewing Records, etc.) are met.
Issuance Procedure
When issuing various certificates, the doctor who examined you must write and confirm them, so
please check the doctor’s office hours before visiting.
STEP 01
Application
STEP 02
Fill out the application form and submit the required documents
STEP 03
Interview with the medical staff in charge
STEP 04
Issuance of copy
STEP 05
Payment and collection
Documents required for issuing medical records, diagnosis, confirmation, etc.
※ (Article 13-2 of the Medical Act) Documents required when a patient or agent requests a copy.
Applicant
Patient
Required Documents
Patient
Principal
- Patient’s identification
(student ID required for those aged 14 to 17 who have not yet been issued a resident registration)
Legal representative (parent, spouse, child) applies
Under 14 years of age
Between 14 and 17 years of age and does not have a resident registration card
17 years of age or older and has a resident registration card
- Guardian (legal representative) identification card
- Family relationship certificate
- Guardian (legal representative) identification card
- Family relationship certificate
- Consent form (Form 2 of Appendix 9, signed by the patient)
- Guardian (legal representative) identification card
- Family relationship certificate
- Consent form (Form 2 of Appendix 9, signed by the patient)
- A copy of the patient’s identification card
Other representative (an applicant other than the patient)
Under 14 years of age
Between 14 and 17 years of age and does not have a resident registration card
17 years of age or older and has a resident registration card
- Applicant’s ID
- Consent form (Form 2 of Appendix 9, signed by the patient)
- Family relationship certificate between the patient and legal representative
- Power of attorney written by the legal representative to the applicant for issuance of a copy
- Copy of legal representative’s identification card
- Applicant’s ID
- Consent form (Form No. 9-2 attached, signed by the patient)
- Power of attorney (Form No. 9-3 attached, signed by the patient)
- Applicant’s ID
- Consent form (Form No. 9-2 attached, signed by the patient)
- Power of attorney (Form No. 9-3 attached, signed by the patient)
- Copy of patient’s identification card
※ (Regarding Article 13-2, Paragraph 3) Documents required when requesting a copy if the patient’s consent cannot be obtained (only relatives may apply)
Applicant
Patient
Required Documents
Patient
If the patient dies
In case of unconsciousness or serious illness or injury that prevents the signature from being handwritten
If the patient is missing
If the patient is incapacitated
- Applicant’s ID
- Documents that can confirm the fact of death, such as
a family relationship certificate (document that can confirm kinship) , a copy of the family register, or a death certificate
- Applicant’s ID
- Family Relationship Certificate (document that verifies family relationship)
- A medical certificate confirming that the patient is unconscious, has a serious illness, or is unable to sign in person
- Applicant’s ID
- Family Relationship Certificate (document that verifies family relationship)
- Documents that can confirm the missing status of the person, such as a copy of the resident registration or a copy of the court’s decision to declare the person missing
- Applicant’s ID
- Family Relationship Certificate (document that verifies family relationship)
- A copy of the court’s decision to sentence a person to incompetence or a psychiatric diagnosis proving that the person is mentally incompetent
Issuance Use Guide
01
Medical record copies are available for issuance Monday through Friday ONLY (9:30 AM – 5:00 PM).
On Saturdays, applications and pre-requested copies can be collected ONLY (9:00 AM – 12:00 PM).
02
Issuance is not possible on public holidays and during lunch hours.(13:00~14:00).
03
If you make a reservation in advance by phone when requesting a copy of your medical records, you can receive it quickly.
