Prijava za turističku dijalizu

Molimo Vas da prijavu uputite 2 sedmice pre termina prve dijalize
Please, send application form to holiday dialysis unit 2 weeks prior to your first dialysis












Format Dan/Mesec/Godina | Format Day/Month/Year




























Molimo Vas da u prijavi popunite sva polja koja su bitna za vašu dijagnozu
Please, fill in all form fields that are relevant for your diagnosis



Od | From
Format Dan/Mesec/Godina | Format Day/Month/Year
Do | To
Format Dan/Mesec/Godina | Format Day/Month/Year


Ponedeljak/Monday
Utorak/Tueday
Sreda/Wednesday
Četvrtak/Thurday
Petak/Friday
Subota/Saturday


HDF
Unesite vrednost od 1 do 3 | Enter value from 1 to 3
HD
Unesite vrednost od 1 do 3 | Enter value from 1 to 3


sati | hours



Molimo, pošaljite kopiju poslednje analize virusološkog statusa, ne starije od 2 meseca.
Please, enclose your last blood results, no older than 2 months.


HBs-ACDaNe | Yes or No

HBs AgDaNe | Yes or No

Anti HCV ACDaNe | Yes or No

Anti HIV ACDaNe | Yes or No

MRSADaNe | Yes or No



Format Dan/Mesec/Godina | Format Day/Month/Year



DaNe




DaNe





G

G







DaNe







ml



ml(IU/ml)



ml(IU/ml)










m2









mmol/l



mmol/l



mmol/l



mmol/l









UI



UI





UI



UI



kg



cm



ml/h




ml/min











mm Hg



mm Hg