Maternity Registration

Maternity Registration

Maternity Registration Form (Eng)

SECTION I: PERSONAL DATA

Antenatal No. *

E.g. : AN2505-0001

Doctor Name *

Staff / Memeber Group (if applicable)

Staff or Dependant

Board-member of Dependant

Associate Doctor or Dependant

Convention Member or Dependant

Chinese Name

Chinese Name (名)

English Name *

English Given Names *

Identity document type *

HKID No. *

Passport No. *

Expiry Date *

Date of Birth *

Occupation

Nationality

Contact No. *

Residential Address *

Email Address *

SECTION II: PERSONAL DATA OF EXPECTANT FATHER

Chinese Name

Chinese Name (名)

English Name

English Name (Given)

Identity document type

HKID No.

Passport No.

Expiry Date

Date of Birth

Occupation

Nationality

Contact No.

SECTION III: PLEASE UPLOAD THE MATERNITY BOOKING FORM*

Please upload the maternity booking form *

Drop a file here or click to upload Choose File

Maximum upload size: 5MB

SECTION IV: PLEASE UPLOAD THE RECIPT*

Please upload the recipt *

Drop a file here or click to upload Choose File

Maximum upload size: 5MB

SECTION V:

Except with the consent of the individual concerned, the personal data collected in this Form will be used for the purpose relating to your healthcare / general related purposes (including, but not limited to, treatment, health care, hospital statistical and audit purposes.)
Note: Please read "Notice to Patient" before you provide any personal data to Hong Kong Baptist Hospital and/or its affiliated medical centers (including, but not limited to, HKBH Ambulatory Medical Centre) (collectively, the "Medical Organization").

SECTION VI: DISCLAIMER

I understand that an advance deposit for maternity booking ("Advance Deposit") is required for registration of maternity service where payment of which is subject to the terms and conditions as set out hereinbelow (subject to changes by the Hospital from time to time):

Advance deposit for a HK resident or non-Mainland China Foreigner is HK$3,000. This deposit serves only to reserve a maternity bed for confinement. It does not constitute a binding agreement with the Hospital or attending obstetrician on the type of clinical obstetric service, bed arrangement or service charges. The clinical service, bed allocation and service charges will be determined according to clinical condition and prevailing hospital policy upon admission for confinement.

The default amount is the advance deposit for the maternity service. Expectant mother who would be required to pay additional deposit on admission.

Booking of Operation Theatre for elective caesarean delivery, which is independent from maternity booking and not included in the Advance Deposit, will be made by the attending doctor, on first-come-first-served basis.

Advance Deposit is non-refundable save and except the following circumstances:
Abortion / Fetus with major congenital abnormalities / Premature delivery (before Week 34 at HA hospital) / Other special condition as approved by our Hospital
Application for refund must be submitted with doctor's written proof and supporting document. In case of abortion / premature delivery, application must be submitted within one month after the procedure, otherwise application will not be considered. HK$2,500 will be refunded for approved application and HK$500 will be charged by the Hospital for administration fee.
Refund will only be released to expectant mother or the authorized person bearing her authorization letter. If the deposit has been made by a credit card/ China Union Pay Card, refund will only be reimbursed back to the same credit card/ China Union Pay Card account.

Confirmation *

I have read and understood the Notice to Patient, "Terms and Conditions for Payment of Advance Deposit for Maternity Bookings (the "Advance Deposit") "、 "Schedule for Advance Deposit for Maternity Booking and Administration Charges" and accepted the above "Terms and Conditions".
I declare that the information given in this form is accurate.