Required Documents

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Required Documents

 

Please make sure to submit the necessary documents when applying for mediation. In addition, it is recommended that you prepare your medical records and related supporting documents in advance for quick appraisal and mediation procedures.

 

Required Documents

Required Documents

1. 조정신청서 2.본인 신분증 사본 3.본인 통장사본 4.조정(중재)신청서 별지 5.민감정보 수집이용 동의서

Additional documents
The following additional documents may be required for professional appraisal and mediation tasks and rapid relief:
Medical institution's medical records
Proof of income
Video (MRI, X-ray, etc.)
Before and after surgery
Receipt of medical expenses
Other related materials

Documents to be submitted by applicant

Documents to be submitted by applicant
division shape Applicant document
patient If the patient is an adult a copy of his her ID card
If the patient is a minor a Family Relation Certificate with a legal guardian (parental guardian)
If the patient cannot express his/her own wishes the guardian (after July 2013, adult guardian or limited guardian) Guardian selection certificate
If deceased (including death of the patient), a family relationship certificate with regard to the heir (the actual person)
Birth certificate for pregnant mother (the actual person) in case of fetal death
Proxy application (family relationship) Agent family relationship certificate· Authorized seal certificate· Power of attorney
Proxy application (without family relationship) Agent representative Authorized seal certificate · Power of attorney
Medical Institutions Representative of a corporation of a medical institution Permission of corporation registration or establishment of medical institution · Representative ID
Private hospital medical institution Copy of medical ID
Copy of the ID of the medical personnel belonging to the medical institution
Proxy applicant Attorney seal certificate, attendance
Common Attorney Representative Attorney

If the required documents are missing, the Korea Medical Mediation and Arbitration Agency may ask the applicant to supplement the data, or the application may be dismissed.