Prints to Download

Regulations

•  Principles of providing health services
•  Regulations for the use of electronic services
•  Regulations of the mobile application
•  Regulations for filing complaints
•  Regulations of the Rehabilitation Department
• Dental treatment guarantee
• Gift Card (aesthetic medicine / cosmetology)
• Principles of personal data processing

Surveys

•  Patient questionnaire - urine sediment cytology
•  PZU Survey - Medical Care
•  Questionnaire for testing for PEMPHIGUS antibodies

Referrals

•  Referral for histopathological examination/biopsy
  
•  Referral for Salmonella and Shigella testing
•  Referral for preventive examinations
•  Referral for psychological examination for the course (forklift operator, backhoe loader, crane, firefighters, city guard)
•  Referral for psychological examination (for drivers)
•  Referral for cytological examination
•  Referral and consent for genetic testing (HCV) LUXMED
•  Referral and consent for genetic testing (HPV, Chlamydia trachomatis) LUXMED
•  EUROIMMUN referral and declaration of consent for genetic testing (BRCA1/BRCA2)
•  Referral for genetic testing (Borrelia burgdorferii, Cytomegalovirus, HBV)
•  Referrals for Anti-HIV Confirmation Test met. WB.
•  Referral for NFZ prenatal tests
•  Referral for molecular testing
•  Referral for molecular testing - Euroimmun
•  Research form for the SANCO test
•  FABER test form
•  Form for blood group identification card
•  Order for HPA-1 Antigen Phenotype Study

Applications and complaints

•  Request for online submission of complaints
•  Claim form
  

Other prints

•  Food diary
•  Patient statement
•  Guardian's statement
•  Consent to vaccination

Detailed information on HIV testing: