Nursing Home and Nursing Home Respite Care

Type Nursing Home
Description

Please note that all Nursing Home referrals must be submitted through IRMS.

Declaration Form (Consent Form) and all Subsidy Deviation Forms (if required) should be added as attachments to the IRMS Nursing Home Application

Form
  1. Nursing Home Referral Form
  2. Declaration Form For NH Application 2017
  3. Subsidy Deviation Forms (if required)
  4. RAF Form
  5. IDP Manual For RHs and CHs MSW Reference V315 August 2016
  6. IDP Agreement Form Aug 2016
  7. Social Report Checklist 2017
  8. Nursing Home Information Toolkit
Type Nursing Home Respite Care (NHRC)
Description Please note that all respite care referrals can be submitted through IRMS from 1 April 2015 onwards
Form
  1. NHRC Referral Form
  2. NHRC Social Report
  3. NHRC Declaration Form
  4. NHRC Medical Report
    • In accordance to MOH guidelines, a chest x-ray result of no more than 6 months is needed for nursing home admission
    • An inpatient discharge summary of no more than 6 months can be submitted in place of the medical report
  5. RAF
    • RAF is required if an inpatient discharge summary is submitted
Contact Information
enquiries@aic.sg
6820 0730

Community Case Management Service (CCMS)

Type Community Case Management Service (CCMS)
Description

Please note that all CCMS referrals are currently received through hardcopy submission.

Please complete all sections of the form for the application to be processed successfully. Include the latest doctor's memo/Discharge Summary and Social Report (if available).

Form
  1. CCMS Referral Form
Contact Information
careconsultant@aic.sg
6820 0725

Medifund

Applications to be initiated by MOH-subsidized Nursing Homes, Chronic Sick institutions and Inpatient hospices for subsidized patients/residents only.
a) Schedule for submissions (Only retrospective bills of up to 6 months will be considered)
Bills incurred for the period from Applications to be submitted to AIC by
1st Apr to 30th Jun 15th Jul
1st Jul to 30th Sep 15th Oct
1st Oct to 31st Dec 15th Jan
1st Jan to 31st Mar 15th Apr
Type Medifund IT System Request
Description

Please use this form for access to Medifund IT system. Please note that applicant must have an existing e-Referral account with AIC.

Form
  1. Medifund IT System Request Form
Contact Information
Irene.ng@aic.sg
6603 6984
6820 0730
Type Medifund Financial Assessment
Description

The template allows the service providers to calculate the net PCI which determines the level of Medifund support.

Form
  1. Medifund Financial Assessment Form (MFA)
Contact information
6603 6984
6593 3981
6593 3866
6820 0730
Type Medifund Self Declaration
Description

In the event that patient/family is unable to produce supporting documents, this form allows patient/family to make declaration on their financial/employment status.

Form
  1. Medifund Self Declaration Form
Contact Information
6603 6984
6593 3981
6593 3866
6820 0730

Medical Fee Exemption Card (MFEC)

Applications to be initiated by MOH-subsidized Nursing Homes, Chronic Sick institutions and Inpatient hospices for subsidized patients/residents only.
a) Criteria of MFEC (updated 15 September 2016)
Type Medical Fee Exemption Card (MFEC)
Description

Applications to be initiated by MOH-subsidized Nursing Homes, Chronic Sick institutions and Inpatient hospices for subsidized patients/residents only.

With effect from 15 September 2016, please submit MFEC card applications via the MFEC system

Contact Information
6603 6984
6593 3866
6820 0730
Type Medical Fee Exemption Card Nursing Home Authorization
Description

To authorized personnel to be the "Person-In-Charge of Institution" and endorse the relevant Medical Fee Exemption Card (MFEC) application.

Form
  1. NH Authorization Form
Contact Information
6603 6984
6593 3866
6820 0730
Financial Assessment Scheme (FAS) for PR MFEC Holders (updated 1 March 2011)
a) Criteria of FAS
b) Checklist for submission
c) Schedule for submissions
Bills incurred for the period of Applications to be submitted to AIC by
1st Apr to 30th Jun 15th Jul
1st Jul to 30th Sep 15th Oct
1st Oct to 31st Dec 15th Jan
1st Jan to 31st Mar 15th Apr
Type Financial Assistance Scheme (FAS)
Description

Applications to be initiated by MOH Medifund-accreditated residential institutions for subsidised patients who are Singapore Permanent Residents with valid Ministry of Health (MOH) AIC or Ministry of Social and Family Development (MSF) Medical Fee Exemption Card or Public Assistance Special Grant Card.

Form
  1. FAS Application Form
Contact Information
6593 3981
6593 3866
6820 0730

Centre-based Service and Home-Based Service

Type Centre-based Service
Description

Please use this form if patient requires services for

  • Day Rehabilitation
  • Day Care / Maintenance Day Care
  • Dementia Day Care

Form
  1. Centre-based Referral Form
Contact Information
6603 6800
6820 0730
Type Home-Based Service
Description

Please use this form if patient requires services for

  • Home Medical
  • Home Nursing
  • Home Therapy
  • Home Help
  • Senior Home Care

Form
  1. Home-based Referral Form
Contact Information
6603 6800
6820 0730

Sheltered Home and Senior Group Home

Type Sheltered Home and Senior Group Home
Description

Please note the Sheltered Home and Senior Group Home referrals are not submitted through IRMS.

Please download application forms and email to socialhomes@aic.sg for referral; other documents required include social report, chest X-ray report, photocopied NRICs, discharge summaries (hospital copy), PT/OT Report (where required), bank statement and any other supporting documents.

Form
  1. Sheltered Home application form
  2. Senior Group Home application form
Contact Information
socialhomes@aic.sg
6820 0730

Psychiatric Sheltered Home

Type Psychiatric Sheltered Home
Description

Please note that all Psychiatric Sheltered Home referrals must be submitted through IRMS.

Please complete all relevant sections of the form for the application to be processed successfully. Declaration Form (Consent Form) and all other supporting documents (if required) should be added as attachments to the IRMS Psychiatric Sheltered Home Application.

Form
  1. Declaration Form for PSH Application
Contact Information
6820 0730

IRMS Change Request Form

Type Change Request
Description

Please use this form for

  • Any change in Biodata information
  • Change of admission date
  • Cancellation of admission

Form
  1. Change Request Form
Contact Information
6603 6995 ( ILTC Portal Helpdesk )
6820 0730