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你的旅程
1. 试管婴儿前期检查
如何在体外受精前准备
Pregnable 培孕宝
2. 体外受精过程
试管婴儿流程指南
试管部门医生&实验室
试管婴儿部门费用
3. 前往泰国
在線預訂
BNH服务
BOOCS健康疗法
儿科
保育室
網上商店
泰国 BNH 医院
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BNH医院在线注册系统
请以英文填写
下列表格中会有档案上传栏位,请您上传有您亲笔签名的护照图片。
请您以中文填写您在中国的永久地址,除此之外请您以英文填写
ASQ : CN New Patient registration
If you are human, leave this field blank.
---Covid-19 Screening assessment---
---新型冠状病毒筛查---
Hotel of Alternative State Quarantine name 替代性自费隔离酒店名称
*
COMO Metropolitan Bangkok
Courtyard by Marriott Bangkok
Evergreen Laurel Hotel Bangkok
Holiday Inn Bangkok Silom
Le Méridien Bangkok
Mercure Bangkok Sukhumvit 11
Novotel Ibis Styles Bangkok Sukhumvit 4
Pullman Bangkok Hotel G
Rembrandt Hotel & Suites Bangkok
Shangri-La Hotel Bangkok
BNH Hospital
Flight Number航班号
*
Which country do you fly from?您从哪个国家乘飞机?
*
Arrival Date到达日期
*
Arrival Time到达时间
*
00:00
00:15
00:30
00:45
01:00
01:15
01:30
01:45
02:00
02:15
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02:45
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03:15
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03:45
04:00
04:15
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04:45
05:00
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06:00
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06:45
07:00
07:15
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07:45
08:00
08:15
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08:45
09:00
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09:45
10:00
10:15
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10:45
11:00
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11:45
12:00
12:15
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12:45
13:00
13:15
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13:45
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16:00
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17:00
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18:00
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19:00
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19:45
20:00
20:15
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20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
Do you experience any of the following respiratory conditions in the last 14 days?在过去14天内,您是否有以下任何呼吸道疾病?
Cough/咳嗽
Sore throat/喉咙疼
Nasal Congestion/鼻塞
Not smell/Anosmia 没有味道/嗅觉缺失
Respiratory tachypnea, Shortness of breath, Dyspnea/呼吸急促,气短,呼吸困难
Do you have a history of fever detected?您有发烧史吗?
*
No fever/没有发烧
Body temperature ≥ 37.5°C/体温高于≥ 37.5°C
Have history of fever/有发烧史
Have you been confirmed COVID-19 infected?您是否曾经被确认感染了新型冠状病毒?
*
Never/从未
Yes, I have/是,曾有
When was diagnosed?诊断报告时间?
*
How are they treated?治疗方式?
*
Treated at home/在家治疗
Admitted in hospital/住院治疗
What is your medical history?您的以往病史?
*
None of the medical history/Don't have any disease 无病史/无疾病
Dyslipidemia/血脂异常
Coronary artery disease (CAD)/冠心病
Diabetes/糖尿病
Renal Failure/肾功能衰竭
Hypertension/高血压
Other/其他
Please specify请说明
*
How is your diabetes control?您的糖尿病控制得如何?
*
Not control/没有控制
Diet control/饮食控制
Insulin Injection/胰岛素注射
Take medication/服用药物
Do you need dialysis?您需要透析吗?
*
No/不需要
Yes/需要
Do you smoke?吸烟史?
*
Yes, I smoke/是,吸烟
No, I don't smoke/否,不吸烟
Do you drink alcohol?饮酒史?
*
Yes, I drink/是,饮酒
No, I don't drink/否,不饮酒
Do you currently taking any medicine?您目前是否服用药物?
*
No, I don't/ 否,没有服用
Yes, I do/是,需服用
Please specify medicine name请注明药品名称
*
How many hours of sleep do you need?您的睡眠时长?
*
Do you need to take sleeping pill?您是否需要服用安眠药?
*
No, I don't/否,不需要
Yes, I do/是,需要
Please specify sleeping pill name请注明安眠药名称
*
Health care coverage / Social security (contracted hospital)医疗保险/社会保障(签约医院)
For social security : Would you like us refer you to contracted hospital ?社保方面:您希望我院把您转诊到签约医院吗?
Yes/是
No/否
The destination after 14 days of quarantine, such as hotel name and etc.检疫14天后的目的地,如酒店名称等等
*
COVID-19 Screening consent新型冠状病毒筛查同意书
*
I agree to do COVID-19 screening test/我同意做新型冠状病毒筛查测试
Please attach file for the COVID-19 test report请附上新型冠状病毒测试报告文件
Click here to upload (Maximum size: 6MB)
Choose File
Maximum upload size: 6MB
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你的旅程
1. 试管婴儿前期检查
如何在体外受精前准备
Pregnable 培孕宝
2. 体外受精过程
试管婴儿流程指南
试管部门医生&实验室
试管婴儿部门费用
3. 前往泰国
在線預訂
BNH服务
BOOCS健康疗法
儿科
保育室
網上商店
泰国 BNH 医院
联系我们
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