OchronaMedyczna.pl OchronaMedyczna.pl






We are at your disposal 24 hours a day, on holidays. We will help you in any unexpected health situations like: accident, illness.

Contact details:
+48 669 793 888 (24h)
transport@ochronamedyczna.pl

Transport Information

Transport From (Full address)
Pick up time:
Transport To (Full address)
Delivery Time:

Patient Inforamtion

Name i Surname:
Date of Birth:
Gender:
History of Diseases Reason for Transport:

Medications (all):

Allergies:

Additional disease:

How the Patient like to be called:
Other important notes:

Ambulance Equipment and Personnel

Equipment:Respirator
Additional bottles of Oxygen
Infusion Pump
Vacuum Mattress
Splints
Incubator
I do not know
Personnel:
Additional information, such as drugs (what drugs, how much)

Purchaser Information

Name i Surname:
Adress:
Phone:
email:
Data for an Invoice
I hereby agree for processing my personal data for purposes of Ochrona Medyczna.pl Sp. z o.o. KRS: 0000341474 (in accordance with the Polish Law of 29.08.1997 on the Protection of Personal Data - Journal. U. Nr 133, poz. 883)


Please rewrite of characters in the box below
This is protection against malicious spammers robots.


Szkolenia e-learning • eSklep • Szkolenia dla Firm • Transport Medyczny • Zabezpiecznia Medyczne • Szkolenia dla Ratowników KDRM 120pkt

©2011 Profesjonalne Centrum Medyczno-Szkoleniowe OchronaMedyczna.pl