Referral System

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يعد SMART QR-RFID بمثابة تغيير جذري في صناعة الرعاية الصحية. نحن ملتزمون بتقديم خدمات رعاية صحية رفيعة المستوى، مدفوعًا بشغفنا بالابتكار والتميز. إن نهجنا المبتكر في خدمات الرعاية الصحية يميزنا عن الباقي، ونحن ملتزمون بتقديم أفضل الخدمات الممكنة لجميع المرضى. إذا كنت تبحث عن مؤسسة رعاية صحية تؤمن بالقيام بما لم يتم القيام به من قبل، فلا تبحث سوى عن SMART QR-RFID.

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Covid-19 Health Declaration

How are you feeling today?

First name

Last name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Patient Type * إلزامي

Domestic

International

Referring Provider Information

Email

Fax

PHC

Receiving Provider Information 1ST CHOICE

Receiving Provider Information 2nd Choice

HIGH CENTER

Select a date * required

Select an Address

Code

Phone

Contact Email

Patient Information

Contact First Name

Contact Last Name

This contact is my

Contact Phone Number

Position

SEX

Company

Referral Objectives

Select an Address

Type of Referral

If Admission what Type of Bed * إلزامي

ICU

WARD

OR

DR

Isolation

Other

If Other please inform us

Reason Of Referral

Does the patient need an interpreter

If yes ,what language

Indication or Diagnosis

History in brief about the Case

TRANSPORTATION

ESCORT

I accept terms & conditions

Videos - Audio - Images - Documents

Upload File

Upload supported file (Max 15MB)

Your Signature

SMART QR-RFID is a game-changer in the healthcare industry. We are dedicated to providing top-notch healthcare services, driven by our passion for innovation and excellence. Our innovative approach to healthcare services sets us apart from the rest, and we are committed to delivering the best services possible to all patients. If you're looking for a healthcare organization that believes in doing what has never been done before, then look no further than SMART QR-RFID.

Thanks for submitting!

Ahmeddehena.com is a revolutionary platform that offers Smart QR RFID cards

ahmedstella6@gmail.com

VAT: 3118468286

SAIP REGISTERATION
NO. 23-12-3733756

download - 2025-09-13T011327_edited_edit

بواسطة

SMART QR-RFID

www.ahmeddehena.org

تم الإنشاء بكل فخر بواسطة

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