Email for non-humans

Information

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Hospital legal name *

Trade name

Hospital type *

General HospitalSpecialty HospitalUniversity HospitalMaternity HospitalPediatric HospitalRehabilitation HospitalOther

Ownership type *

PrivatePublicNGOMilitaryOther

Year established

Commercial registration number

Tax/VAT number

Ministry of Health license number

Accreditation status

JCINational AccreditationISONoneOther

Accreditation validity date

Contact

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Main phone number

Secondary phone number

WhatsApp number

General email address *

Website

Country *

Saudi ArabiaUnited Arab EmiratesQatarKuwaitOmanBahrainLebanon

City

District / Area

Full address

Postal code

Google Maps location link

Authorization

Authorization Previous Next

Full name *

Job title

Department

Mobile number *

Email address *

Preferred contact method *

• Phone
• Email
• WhatsApp

Commercial

Commercial Previous Next

Full name *

Job title

Mobile number

Email address

Director

Director Previous Next

Full name *

Specialty

License number

Mobile number

Email address

Billing Contact

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Full name *

Job title

Mobile number

Email address

Claims

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Full name *

Job title

Mobile number

Email address

Capacity

Capacity Previous Next

Number of licensed beds

Number of operational beds

Number of ICU beds

Number of NICU beds

Number of operating rooms

Number of emergency beds

Number of dialysis units

Number of labor and delivery rooms

Number of outpatient clinics

Number of ambulance units

Pharmacy available

YesNo

Blood bank available

YesNo

Radiology department available

YesNo

Laboratory available

YesNo

Cath lab available

YesNo

Endoscopy unit available

YesNo

Services

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Clinical Services Available *

• Toggle All
• Emergency Medicine
• Internal Medicine
• General Surgery
• Orthopedic Surgery
• Cardiology
• Cardiovascular Surgery
• Neurology
• Neurosurgery
• Pediatrics
• Neonatology
• Obstetrics & Gynecology
• Oncology
• Hematology
• Nephrology
• Dialysis
• Urology
• ENT
• Ophthalmology
• Dermatology
• Plastic Surgery
• Gastroenterology
• Pulmonology
• Endocrinology
• Psychiatry
• Rehabilitation / Physiotherapy
• Radiology / Imaging
• Pathology / Laboratory
• Dental / Maxillofacial
• Other

Emergency

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24/7 emergency department

YesNo

24/7 operating room

YesNo

24/7 ICU coverage

YesNo

Trauma care available

YesNo

Stroke management available

YesNo

Cardiac emergency management available

YesNo

Ambulance service

• Owned
• Outsourced
• Not available

Gallery

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Gallery

Upload Images

Upload up to 4 images

Upload

Billing

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Billing system name

HIS / EMR system name

Electronic medical records available

YesNo

E-claims supported formats

Average claim submission period

Within 24 hours2–3 days4–7 daysMore than 7 days

Average response time for insurer queries

Ability to submit itemized bills

YesNo

Ability to submit discharge summaries electronically

YesNo

Bank

Bank Previous Next

Bank name

Branch name

Account name

Account number

IBAN

SWIFT code

Preferred payment currency

Documents

Documents Previous Next

Hospital license

File name:

File size:

Commercial registration certificate

File name:

File size:

Tax/VAT certificate

File name:

File size:

Accreditation certificate

File name:

File size:

Authorized signatory ID/passport copy

File name:

File size:

Bank certificate / bank letter

File name:

File size:

Hospital profile / brochure

File name:

File size:

List of specialties and consultants

File name:

File size:

Sample official stamp

File name:

File size:

Signed terms and conditions

File name:

File size:

Other supporting documents

File name:

File size:

Declaration

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Declaration *

• We hereby confirm that all information provided is true and accurate.
• We agree to notify the insurance company of any changes in licensing, accreditation, ownership, services, or contact details.
• We consent to review, audit, and credentialing procedures as required by the insurance company.

Signature

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Authorized signatory full name *

Title *

Date *

Signature

File name:

File size:

Hospital stamp

File name:

File size:

Submit