OPAN® • Online Patient Registration for Spitex

Information about the assignment

Earliest possible first use on site
Tuesday, January 28, 2025 between 10 and 12 pm

Desired first use

After consultation with the customer

As soon as possible

Specific date and time of day

Date and Time of day

Time

Location of operation
Street, Nr.

c/o address

Postal Code, City

Care needs, care assignment and further care instructions
Care needs

Care assignment

Living/Housing situation

Acute transitional care
Yes, the care request falls under ATC

Reason for application
Main diagnosis / Reason for application

Secondary diagnosis / information relevant for care

Further remarks

Family doctor informed
The family doctor is aware of this registration

Medication and material
Current medication

Medication and material supply

No medication or material is required

Required medication or material is organized independently by the patient or relatives

Medication or material needed is given to the patient

Other

Medication and material details

Documents
Attachment
Patient data / customer data

First name

Last name

Gender

Date of birth

AHV number

Home address
Different residential address?
Yes, the patient's/client's residential address is not at the location of operation

Street, Nr.

Address suffix

Postal Code, City

Country

Additional data
Civil status

Religious denomination

Spoken languages

Nationality

E-mail of the patient / customer

Insurances

Event

Accident date

Accident number

Relatives / Reference person

First name

Last name

Relationship

Administrative contact person
Yes, please contact this person for everything Administrative

Main number

Email

Street, Nr.

c/o address

Postal Code, City

Country

Supervising / responsible physicians
Who fills in this application?

Sender

Other
Not listed in directory

Name

Responsible person for queries
Salutation

First name

Last name

Email

Alternative email

Reachability
Reachability

Contact options

Responsible person asks to be contacted

Contact patient / client directly

Preferred contact option for queries by telephone

Preferred contact option for queries by email

Additional information

I hereby confirm

The patient / customer is informed about the registration and agrees

I agree with the terms of use and the privacy policy

Security & Privacy

Cancel

Who fills in this application?
Application
Confirmation

Referrer

Provider

Login

Register

No account yet?

Language selection

OPAN® • Online Patient Registration for Spitex

Spitex • Application