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Ummer Gatuadress Telefonnummer Postnummer Ort Mobilnummer 2. Beskriv dina besvär mm: 3. Aktuell livssituation inklusive familjeförhållanden: 4. Eventuella tidigare traumatiska upplevelser: 5. Frågeställning / Begäran: 6. Vilka vårdkontakter har du? (exempelvis vårdcentral, specialkliniker/centrum) Vilka läkemedel använder du? 7. Om annan fyller i blanketten: Är personen medveten om att remiss skrivits? Ja Behövs tolk? Ja Nej Nej Språk: [Välj önskat språk eller skri.

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How to fill out the SE Flyktingmedicinskt Centrum online

Filling out the SE Flyktingmedicinskt Centrum form online is an essential step for individuals seeking medical assistance regarding trauma and crisis situations. This guide will help you navigate each section of the form with clarity and confidence.

Follow the steps to complete your application accurately.

  1. Click ‘Get Form’ button to obtain the form and open it in your online editing tool.
  2. Provide your personal information. Fill in your first and last name, personal identification number (personnummer) or date of birth along with your LMA number, street address, telephone number, postal code, city, and mobile number.
  3. Describe your current health issues and concerns in the designated section. Be clear and detailed about your symptoms.
  4. Outline your current living situation, including your family circumstances, in the specified area of the form.
  5. Discuss any past traumatic experiences you have encountered in the provided section. This information is crucial for your assessment.
  6. Indicate the specific questions or requests you have regarding your care. Be concise and direct.
  7. List any healthcare contacts you currently have, such as clinics or specialty centers. Also, indicate any medications you are currently using.
  8. If someone else is completing the form for you, indicate whether the person is aware that a referral has been written. Select if an interpreter is needed and specify the language required.
  9. Provide the date and signature in the designated section. Include your name clarification and a contact detail (address or phone number) if someone else filled out the form.
  10. The form will be sent to: Flyktingmedicinskt centrum, Kris- och traumamottagningen. Ensure all information is correct before submitting.

Complete your SE Flyktingmedicinskt Centrum document online today.

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