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About Children’s Hospital
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我们的医生
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反馈信息
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Claim Process for Inpatients
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就诊期间
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寻找医生
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泰国及曼谷信息
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计划就诊
Finding a Hotel
术后关照
医疗记录及报告
账务及账单信息
药物信息
就诊后咨询
计划与服务
重症监护中心
Well Application
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Referrals for Pediatric Patients
高龄友好医院
Total Vaccine Solution
Online Medication Refill
Total health solutions
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Health Risk Score
我们的便利设施
Chivawattana会员卡
公司人员健康
联系我们
Careers
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新患者在线预前注册
线上预前注册 (成人)
Back to Home
线上预前注册
(成人)
门诊注册信息表
请准确完成地填写表格。确保所有线上预前注册信息已提交,所有隐私信息已加密处理。
1
患者信息
2
紧急联络方式
3
财务及保险
4
个人历史
*必填
位置*
位置*
三美泰素坤逸医院
三美泰诗娜卡琳医院
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女士*
女士*
男士
夫人
女士
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名字*
名字*
姓氏*
姓氏*
性别*
性别*
男
女
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国籍*
国籍*
Afghan
Albanian
Algerian
American
Andorran
Angolan
Antiguans
Argentinean
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Barbudans
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Beninese
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Latvian
Lebanese
Liberian
Libyan
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Lithuanian
Luxembourger
Macedonian
Malagasy
Malawian
Malaysian
Maldivan
Malian
Maltese
Marshallese
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Mexican
Micronesian
Moldovan
Monacan
Mongolian
Moroccan
Mosotho
Mozambican
Namibian
Nauruan
Nepalese
New Zealander
Nicaraguan
Nigerian
Nigerien
North Korean
Northern Irish
Norwegian
Omani
Pakistani
Palauan
Panamanian
Papua New Guinean
Paraquayan
Peruvian
Polish
Portuguese
Qatari
Romanian
Russian
Rwandan
Saint Lucian
Salvadoran
Samoan
San Marinese
Sao Tomean
Saudi
Scottish
Senegalese
Serbian
Seychellois
Sierra Leonean
Singaporean
Somali
South African
South Korean
Spanish
Sri Lankan
Sudanese
Surinamer
Swazi
Swedish
Swiss
Syrian
Taiwanese
Tajik
Tanzanian
Thai
Togolese
Tongan
Trinidadian or Tobagonian
Tunisian
Turkish
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbekistani
Venezuelan
Vietnamese
Welsh
Yemeni
Zambian
Zimbabwean
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宗教
宗教
Buddhism
Catholic
Christian
Confucianism
Hinduism
Islam
Jainism
Judaism
Shinto
Sikhism
Tao
Unknown
Zen
Zoroastrianism
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是否为常驻*
是
否
婚姻状态*
已婚
离异
僧侣
单身
丧偶
身份证/护照号码*
ID CARD
Passport No.
ID CARD*
ID CARD*
职*
职*
国家*
国家*
Thailand
Aruba
Afghanistan
Angola
Anguilla
Albania
Andorra
Netherlands Antilles
United Arab Emirates
Argentina
Armenia
American Samoa
Antarctica
French Southern Territories
Antigua and Barbuda
Australia
Austria
Azerbaijan
Burundi
Belgium
Benin
Burkina Faso
Bangladesh
Bulgaria
Bahrain
Bahamas
Bosnia and Herzegovina
Belarus
Belize
Bermuda
Bolivia
Brazil
Barbados
Brunei Darussalam
Bhutan
Bouvet Island
Botswana
Central African Republic
Canada
Cocos (Keeling) Islands
Switzerland
Chile
China
Ivory Coast
Cameroon
Congo, The Democratic Republic
Congo
Cook Islands
Colombia
Comoros
Cape Verde
Costa Rica
Cuba
Christmas Island
Cayman Islands
Cyprus
Czech Republic
Germany
Djibouti
Dominica
Denmark
Dominican Republi
Algeria
Ecuador
Egypt
Eritrea
Western Sahara
Spain
Estonia
Ethiopia
Finland
Fiji
Falkland Islands (Malvinas)
France
Faroe Islands
Micronesia, Federated States
Gabon
United Kingdom
Georgia
Ghana
Gibraltar
Guinee
Guadeloupe
Gambia
Guinea-Bissau
Equatorial Guinea
Greece
Grenada
Greenland
Guatemala
French Guiana
Guam
Guyana
Hong Kong
Heard and McDonald Islands
Honduras
Croatia
Haiti
Hungary
Indonesia
India
British Indian Ocean Territory
Ireland
Iran (Islamic Republic Of)
Iraq
Iceland
Israel
Italy
Jamaica
Jordan
Japan
Kazakstan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Saint Kitts and Nevis
Korea, Republic of
Kuwait
Lao People's Democratic Rep
Lebanon
Liberia
Libyan Arab Jamahiriya
Saint Lucia
Liechtenstein
Sri Lanka
Lesotho
Lithuania
Luxembourg
Latvia
Macau
Morocco
Monaco
Moldova, Republic of
Madagascar
Maldives
Mexico
Marshall Islands
Fmr Yugoslav Rep of Macedonia
Mali
Malta
Myanmar
Mongolia
Northern Mariana Islands
Mozambique
Mauritania
Montserrat
Martinique
Mauritius
Malawi
Malaysia
Mayotte
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Niue
Netherlands
Norway
Nepal
Nauru
New Zealand
Oman
Pakistan
Panama
Pitcairn
Peru
Philippines
Palau
Papua New Guinea
Poland
Puerto Rico
Korea, Democratic People's Rep
Portugal
Paraguay
French Polynesia
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saudi Arabia
Sudan
Senegal
Singapore
Sth Georgia & Sth Sandwich Is
Saint Helena
Svalbard and Jan Mayen
Solomon Islands
Sierra Leone
El Salvador
San Marino
Somalia
Saint Pierre and Miquelon
Sao Tome and Principe
Suriname
Slovakia
Slovenia
Sweden
Swaziland
Seychelles
Syrian Arab Republic
Turks and Caicos Islands
Chad
Togo
Tajikistan
Tokelau
Turkmenistan
East Timor
Tonga
Trinidad and Tobago
Tunisia
Turkey
Tuvalu
Taiwan, Province of China
Tanzania, United Republic of
Uganda
Ukraine
US Minor Outlying Islands
Uruguay
United States
Uzbekistan
Holy See (Vatican City State)
St Vincent and the Grenadines
Venezuela
Virgin Islands (British)
Virgin Islands (U.S.)
Viet Nam
Vanuatu
Wallis and Futuna Islands
Samoa
Yemen
Yugoslavia
South Africa
Zambia
Zimbabwe
Republic of Montenegro
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现居地址*
现居地址*
邮箱*
邮箱*
是否与永久住址相同*
是
否
下一步