Cruise Dialysis

Dialysis Unit Information Form (DASC)

Dialysis Unit Information Form DASC
Does this patient use a wheelchair or mobility scooter?
Patient's MRSA status
Patient's Hepatitis B status
Patient's Hepatitis C status
Is this patient currently in treatment for VRE?
Dialysis Unit Postal Address
Dialysis Unit Postal Address
City
State/Province
Zip/Postal
Country