*表格乃掃描版本
**表格乃掃描版本並只供參考用途
Willis Towers Watson
WTW Consultation Record
WTW - Work Injury Report
WTW - Reminders for Clinic
WTW - GP Panel
*Do Not Show to Patient*
WTW - Veolia - TKOL Signatures
WTW - Authorized Signatures
WTW - Able Construction Signatures
WTW - Waylung Waste
Services Limited
WTW - Design & Construction of Light
Public Housing at Lok On Pai
(Contract No SS M520)
WTW - Jollibee HK Meko Holdings Ltd
WTW - Jollibee Chops
WTW - Jollibee Signatures
注意事項：
Request Form for Medical Services
．傳真或影印本均可接受
．醫務所服務員必須核對病人身份證上的名字跟 Form 上一樣
．必須得到主管 / 安全主任的簽署及印鑑
．病人必須於表格上簽署，以授權天一醫務所將其資料交予僱主
．清楚記錄病人的診斷結果
Consultation Record Form
．填寫病人的診症日期、病人姓名、診斷項目、收費及病況表格上
．病人必須於表格上簽署
．每位病人單獨使用一張表格
Work Injury Report
．病人須於 Report 上簽署
．醫生須於 Report 上簽署及蓋印
．將 Report 掃描及上載
WTW Client List - please email the reports to Rita and Maggie (Please obtain approval from WTW for cases over $2,000)
. Sun Fook Kong Construction (**所有檢查報告（包括 Xray 等），可於即日交回病人簽收。)
. Veolia China Holding Limited
. Securitas Security Services (Hong Kong) Limited
. Dragages Hong Kong Limited
. Waylung Waste Services Limited
. Able Engineering Company Limited / Able Building Construction Limited
. Jolibee Hong Kong Meko Holdings Limited 2024/9/1-2025/8/31 (**所有檢查報告（包括 Xray 等），可於即日交回病人簽收。)
請代保存所有文件直至工傷的 case 完結
將 Request Form 及 Work Injury Report 掃描到 Clinic Solution
將 Request Form 及 Consultation Form 交到 CSC
收費指引：
病人不需繳付任何費用，請記帳 Willis Towers Watson
