MSQH Electronic Hospital Accreditation Program (My e-HAP)

Access Application Form

  1. The My e-HAP access shall be requested by the Person in Charge of the Facility; the person to whom all MSQH correspondence is sent.
  2. The Person in Charge shall indicate approval for access for respondents by completing the particulars in the form.
  3. Please note that only one time access will be issued to your Facility, however if there is any change of personnel in the Facility at administrator or respondent level, please request a new access. The current access will be invalidated once a new access is issued
  4. Please send the scanned copy of the completed application form via fax at 603 2681 3199 or email to . The access approval will be mailed to the Person in Charge of the Facility, within 5 working days.

Facility’s Particulars
Name of Facility / ______
Corporate Ownership / ______
Phone / ______/ Fax / ______
Primary Email / ______/ Alternative email / ______
Address Name / ______
Street1 / ______/ Street 2 / ______
City / ______/ Postcode / ______
State / ______/ Country / Malaysia
Reason for Requesting an access
New application / Access has Expired/revoked
Forgotten the access username and password / Did not received the access
Administrator has left the Facility / Misplaced the access
Personal Particular of Applicant
Name of applicant / ______
Designation / ______/ Email / ______
Contact No / ______(O) / ______(HP)
Signed on behalf of the above facility
I hereby accept the terms and conditions as stated / FOR OFFICE USE ONLY
Person in Charge / Approved by,
……………………………………………….
(Please print name & stamp) / Date ………………………………………...
Remarks ……………………………………
……………………………………………….
Name / ______/ Account No / ……………………..
Date / ______

MSQH Electronic Hospital Accreditation Program (My e-HAP)

Access Application Form

Level of access: Administrator Level

Note: The administrator level must be hold by a Person in Charge of the Facility

No / Name / Designation / Email
1
2

Level of access: Respondent Level

No / Service Standards / Salutation / Name of Respondent / *Designation / Email
1 / Choose an item. /
2 / Choose an item. /
3 / Choose an item. /
4 / Choose an item. /
5 / Choose an item. /
6 / Choose an item. /
7 / Choose an item. /
Choose an item. /
9 / Choose an item. /
10 / Choose an item. /
11 / Choose an item. /
12 / Choose an item. /
13 / Choose an item. /
14 / Choose an item. /
15 / Choose an item. /
16 / Choose an item. /
17 / Choose an item. /
18 / Choose an item. /
19 / Choose an item. /
20 / Choose an item. /
21 / Choose an item. /
22 / Choose an item. /
23 / Choose an item. /
24 / Choose an item. /
25 / Choose an item. /
26 / Choose an item. /
27 / Choose an item. /
28 / Choose an item. /
29 / Choose an item. /
30 / Choose an item. /
31 / Choose an item. /
32 / Choose an item. /
33 / Choose an item. /
34 / Choose an item. /
35 / Choose an item. /

MSQH Standards for Chronic Dialysis Treatment

No / Service Standards / Salutation / Name of Respondent / Designation / Email
36 / Chronic Dialysis Treatment