Holiday dialysis: medical records

Parameters for dialysis treatment

Type of artificial kidney

Dialysate composition

Anticoagulants

If Heparin, also enter initial and continual doses

Vascular access: (one or both; alternatively, select ‘not applicable’)

Medication received during dialysis

Blood-borne infection serological results (max. 1 month old)

Result + date

Result + date

Result + date

Result + date

Other results

Result + date

Result + date

Bestanden moeten kleiner zijn dan 2 MB. Toegestane bestandstypen: gif jpg jpeg png pdf doc docx xls xlsx xml.

estanden moeten kleiner zijn dan 2 MB. Toegestane bestandstypen: gif jpg jpeg png doc docx xls xlsx xml.

Bestanden moeten kleiner zijn dan 2 MB. Toegestane bestandstypen: gif jpg jpeg png pdf doc docx xls xlsx xml.

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