Forms

Attention!!! Need of KP "TMO "SMOL" (8 types of forms, paper type: white offset paper, density not less than 80 g/m2, black and white printing, if necessary, we can send samples of forms by e-mail (the format of the forms is visible on the samples)). List of forms: 1) Medical examination form for persons to determine fitness for a particular type of activity by health status No. 140-5/o – 1000 pcs. 2) Employee card subject to preliminary (periodic) medical examination – 3000 pcs. 3) Employee card subject to OMO (preliminary, periodic, unscheduled) – 5000 pcs. 4) Patient card of a discharged patient No. 066/o – 11000 pcs. 5) Informed voluntary consent of the patient for diagnostic, treatment, surgery and anesthesia No. 003-6/o – 16000 pcs. 6) Temperature chart No. 004/o – 11000 pcs. 7) Doctor's prescription form No. 003-4/o – 11000 pcs. 8) Inpatient medical record No. 003/o – 11000 pcs. Attention!!! Need of VP Maternity hospital (11 types of forms, paper type: white offset paper, density not less than 80 g/m2, black and white printing, if necessary, we can send samples of forms by e-mail (the format of the forms is visible on the samples)). List of forms: 1) Insert No. 1, 2, 6, 8 No. 096/o – 1000 pcs. 2) Newborn medical card No. 097/o – 1000 pcs. 3) Record of patient movement and bed fund of the hospital No. 007/o – 2000 pcs. 4) Doctor's prescription form No. 003/-4o – 4000 pcs. 5) Temperature chart No. 004/o – 4000 pcs. 6) Patient card of a discharged patient No. 066/o – 3000 pcs. 7) Informed voluntary consent of the patient for diagnostic, treatment, surgery and anesthesia No. 003-6/o – 1000 pcs. 8) Informed consent of parents for neonatal screening Addendum 1 (p.3 p.1) – 1000 pcs. 9) Portion list for patient nutrition No. 1-84 – 3000 pcs. 10) Employee work schedule No. 214 – 100 pcs. 11) Time sheet for used working time No. 497 – 100 pcs. Attention!!! Need of VP "Children's Hospital" (10 types of forms, paper type: white offset paper, density not less than 80 g/m2, black and white printing, if necessary, we can send samples of forms by e-mail (the format of the forms is visible on the samples)). List of forms: 1) Doctor's prescription form F 003-4/0 — 2000 pcs. 2) Informed consent for treatment F No. 003-6/0 — 2000 pcs. 3) Individual rehabilitation program for a child with disabilities from 0–18 years — 800 pcs. 4) Menu-requirement for products — 1000 pcs. 5) Requisition for the release of products from the warehouse to the kitchen for the preparation of meals for patients — 300 pcs. 6) Patient card of a discharged patient from the hospital No. 066/0 — 2000 pcs. 7) Inpatient medical record F No. 003/0 — 2000 pcs. 8) Temperature chart F 004/0 — 2000 pcs. 9) Informed consent of a person for psychiatric examination F 003-7/0 — 400 pcs. 10) Informed consent of parents or other legal representative for outpatient psychiatric care for a child under 14 years of age F 003-12/0 — 400 pcs. Attention!!! Need of VP "Intensive Care Hospital" (10 types of forms, paper type: white offset paper, density not less than 80 g/m2, black and white printing, certain forms by the customer are color printing, if necessary, we can send samples of forms by e-mail (the format of the forms is visible on the samples)). List of forms: 1) Blood test for blood group and Rh factor, F. 207/o — 20000 pcs. 2) Blood test for Wassermann reaction, F. 241/o — 2000 pcs. 3) Biochemical blood test, F. 228/o — 19000 pcs. 4) Fasting blood glucose — 20000 pcs. 5) General urine test, F. 210/o — 28000 pcs. 6) Day hospital card of the polyclinic — 1000 pcs. 7) Intensive care card and main patient condition indicators — 8000 pcs. 8) Clinical blood test, F. 224/o — 10000 pcs. 9) Coagulogram, F. 237/o — 3000 pcs. 10) Menu-layout — 2000 pcs.

Items: Forms for medical institutions, A4 (210x297 mm), according to the Customer's sample (Forms) [CPV: 22820000-4]

Procuring entity: Communal non-profit enterprise of Stryi City Council "Territorial Medical Association "Stryi City United Hospital"