MH 34:24/8

Circular No 81/2020

19 Mar 2020

CEOs, GMs & MDs of Private Hospitals

CEOs, CMBs of Public Healthcare Institutions
Selected Private Specialist Clinics

GUIDANCE ON THE APPROACH FOR FOREIGN PATIENTS HOLDING ASEAN

PASSPORTS SEEKING MEDICAL CARE AT PUBLIC & PRIVATE HOSPITALS IN
THE CONTEXT OF HEIGHTENED ALERT FOR COVID-19

BACKGROUND

MOH had announced that from 20 Mar 2020, 23:59hrs, all travellers entering
Singapore will be issued a 14-day Stay Home Notice (SHN). Furthermore, all short-
term visitors who are nationals of any ASEAN1 country must submit requisite
information on their health condition for clearance (ASEAN Health Clearance (AHC))
at https://go.gov.sg/healthclearance at least 14-21 days before their intended date of
travel into Singapore. All applicants must ensure that their applications have been
approved by MOH before their travel to Singapore. Approved applications will be
verified by the Immigration and Checkpoints Authority (ICA) officers at the Singapore
checkpoints.

2. Short-term visitors who arrive in Singapore without the necessary approval, or

proof of the place where they will serve the 14-day SHN, or do not meet prevailing
entry requirements, will be denied entry into Singapore.

3. This Circular provides guidance to all public and private hospitals, and private
specialist clinics on the approach to managing foreign patients holding ASEAN
passports who are seeking specialist medical care in Singapore.

4. Please note that the MOH Directive 02/2020 (Annex A) on additional measures
for medical evacuations into Singapore remains applicable. For medical evacuations
involving ASEAN passport holders, the requirement for AHC will be waived if the

1
ASEAN countries besides Singapore: Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar,
Philippines, Thailand, Vietnam
relevant requirements for medical evacuation (based on MOH Directive 02/2020) are
met.

DO NOT ACCEPT NEW MEDICAL APPOINTMENT REQUESTS FROM FOREIGN

PATIENTS

5. All public and private hospitals, and private specialist clinics should immediately
stop or defer accepting new medical appointment requests from foreign patients
who do not reside in Singapore (“foreign patients”) until further advised by MOH.
This measure is important as we seek to conserve limited healthcare resources for
Singapore to cater to managing COVID-19 cases as well as the existing needs of our
local patients.

EXISTING FOREIGN PATIENTS HOLDING ASEAN PASSPORTS ON FOLLOW-UP

WITH SPECIALIST IN SINGAPORE

6. For all existing foreign patients holding ASEAN passports on active follow-up
with a specialist in Singapore, the attending specialist should, in the first instance,
encourage the patient to seek or continue care in their home country.

7. Patients who require continued specialist care in Singapore should apply for
AHC well in advance of their medical appointment. They must not have visited any
hospital outside Singapore from 14 days before time of application for AHC until their
visit to Singapore, to be eligible for the AHC approval.

8. The attending specialist should only apply to MOH for a waiver of the
requirement for AHC on patient’s behalf (Annex B) if:

i. The foreign patient has healthcare needs requiring specialist management that
cannot be met in the home country AND

ii. The patient is currently under the attending specialist’s active follow-up AND

iii. The attending specialist certifies that delay in continuation of treatment (e.g. of 14-
21 days) will lead to serious adverse outcomes.

The completed Annex B should be sent in PDF format to

MOH_Hospital_Services@moh.gov.sg for MOH’s review. MOH will review and reply
to the application via email within one week. If the waiver is approved, MOH will send
a letter to the applying specialist to confirm the waiver (Annex C). The specialist
should then send this to the patient (and any accompanying visitor) for them to produce
to the airline and ICA officers at the border checkpoint for inspection.

9. The attending specialist is responsible for informing the patient (and

accompanying visitor) of the conditions set out in para 10 and will be responsible for
ensuring that they comply to the conditions. The attending specialist and healthcare
institution need to:

a. Have a workflow in place to ensure that the patients can enter the hospital, go for
their medical consultation and treatment etc. such that there is minimal contact with
other patients/ hospital visitors. This includes the appropriate use of personal
protective equipment (PPE) by healthcare workers when caring for the patient. The
patient (and any accompanying visitor) should be managed as for close contacts
of confirmed COVID-19 cases with regard to precautionary measures.

b. Inform MOH at MOH_Hospital_Services@moh.gov.sg when the patient (and

any accompanying visitor) arrive in Singapore, is discharged from the healthcare
facility, if the patient requires ICU care and on departure.

10. The attending specialist should inform the patient of the following prior to
his/her departure:

a. He/she should have no more than 1 accompanying visitor to Singapore;

b. He/she (and accompanying visitor) must clear health checks at the Singapore
immigration checkpoint and may be subjected to a swab test before being allowed
into the country;

c. He/she (and accompanying visitor) will need to produce proof of the place where
they will serve the 14-day Stay Home Notice (SHN) on arrival;

d. He/she (and accompanying visitor) will be put on 14-day Stay Home Notice (SHN)
upon arrival in Singapore and will not be allowed to depart prior to completing the
14-day SHN. He/she (and accompanying visitor) will be allowed to leave their
residence for medical appointments but must liaise with the SHN duty officer
beforehand;

e. He/she (and accompanying visitor) should monitor their temperature and health for
at least the first 14 days following arrival, and seek medical attention early if unwell.
If the patient develops fever or any respiratory symptoms, he/she should be
admitted to the attending specialist’s hospital, isolated and tested for COVID-19 (2
tests at least 24 hours apart);

f. Beyond the end of the SHN period, he/she (and accompanying visitor) should limit
their travel to the minimum beyond travelling between the healthcare facility and
their residence, and avoid crowded places while they are in Singapore;

g. Waivers will not be granted for future care episodes once he/she departs from
Singapore. Future care episodes requiring travel to Singapore should be planned
well in advance, and will need to go through the usual AHC application process.
11. The above is for all public and private hospitals’, and private specialist clinics’
immediate compliance. Please ensure that the contents of this circular are brought to
the attention of all relevant personnel in your institution. Failure of the specialist to
comply with the above may adversely impact public health and safety, and as such,
will result in more stringent considerations of subsequent applications by MOH.

A/PROF KENNETH MAK

DIRECTOR OF MEDICAL SERVICES
MINISTRY OF HEALTH