ST2 Immunization Record & Insurance

ST2 Immunization Record & Insurance

This form should be submitted by 1 month before you start the program.
Name*

First NameLast Name
Your Institution*
Country*
Email*
Medical Students/Residents/Fellows ElectiveIFMSA SCOPE-SCOREASEAN Doctors ScholarshipShort Training CourseOther

Passport & Visa
Passport Number*
Passport Expiry Date*

MonthDayYear
Date of Arrival*

MonthDayYear
The day you will arrive in Thailand
Date of Departure*

MonthDayYear
The day you will leave Thailand
Please attach a copy of your passport bio data page*

Cancelof
YesNo
Note: Please check whether you need to apply for a visa via https://www.thaievisa.go.th/
Please attach a copy of your E-VISA

Cancelof
Immunization Record
ST2 Form - Immunization Record
Please use the template we have provided for immunization records as shown above. If you already have existing records that include all the required fields from our template, you may upload those instead.

For TDap and Seasonal Influenza vaccinations, if these vaccines are unavailable in your country, we suggest consulting with medical professionals first. Alternatively, you may choose to receive these vaccinations at our hospital before beginning your program, noting that fees will apply.

We strongly encourage all participants to get vaccinated as recommended for their health and safety.
Immunization record*

Cancelof
Insurance
Health and Travel Insurance Requirements for Participants in Thailand

Participants are required to secure comprehensive health and travel insurance prior to their stay in Thailand. The insurance must adequately cover the following aspects:
1. Health Coverage: This includes medical expenses related to illness, injuries, and specifically COVID-19.
2. Travel-Related Coverage: Protection against losses, delays, cancellations, and damages.
3. Emergency Situations: Coverage for accidents, natural disasters, and incidents of terrorism.
4. The participant who will attend at least a 3-month program has to obtain liability insurance and/or Medical Malpractice Insurance.
It is essential that the insurance also includes medical care provisions in hospitals in Thailand. Proof of coverage, provided in English, must be submitted after official acceptance and prior to the commencement of the program. Please note that we will not assume responsibility for any costs incurred by participants related to these insurance requirements.

Important Considerations:
- Participants are urged to verify with their insurance provider regarding partnerships or contracts with any of the Thai hospitals, as neither Siriraj Hospital nor SiPH processes fax claims.
- In the event that you process treatment at Siriraj or SiPH, you will need to pay for any inpatient or outpatient treatments upfront. You will then have the option to seek reimbursement from your insurance company upon returning to your home country by requesting a medical certification and receipt in English.
- If applicable, participants may pursue a direct claim process through their insurance agents from their home countries for any treatment incurred.
We advise all participants to choose their insurance provider carefully, ensuring that they can receive needed medical treatment without incurring out-of-pocket expenses during their stay.
Insurance Proof*

Cancelof
Other
YesNo
Should be Empty:

ST2 Immunization Record & Insurance

Passport & Visa

Immunization Record

Insurance

Other