Downloads Forms and applications Downloadable Forms Donor Inquiry Form 15Reporting serious adverse event-response The request for compensation for loss of earnings Request for contribution to the costs of a funeral Funeral costs-reimbursement for foreigners Lost income-Remuneration for foreigners Affidavit Affirmation – adult stranger Affirmation – an alien child Checklist CHECKLIST Appendix A TC audit Kidney rev 1 CHECKLIST TC audit SMQ rev 2 Waiting list Inclusion / exclusion-other authorities Inclusion / exclusion kidney-PDF for PRINT Inclusion / exclusion kidney-filling ONLINE Inclusion / exclusion vessels fresh-cryo Applications Changing the payment mechanism of transport of the body of the deceased organ donor The request for compensation for loss of earnings Request for contribution to the costs of a funeralFuneral costs-reimbursement for foreigners Lost income-Remuneration for foreigners ICSR / NR Reports of reap-R Reports solve reap-R Funeral Services Name of funeral services (Required) E-mail (Required) Phone Donor identification number (Required) Please, enter the number of Health insurance of recipients. 9 + 7 = Submit Insurance companies Name of requesting insurance (Required) Name of requesting insurance (Required)111 - Všeobecná zdravotní pojišťovna ČR (VZP)201 - Vojenská zdravotní pojišťovna ČR (VoZP)205 - Česká průmyslová zdravotní pojišťovna (ČPZP)207 - Oborová zdravotní pojišťovna zam. bank, poj. a stav. (OZP)209 - Zaměstnanecká pojišťovna Škoda (ZPŠ)211 - Zdravotní pojišťovna ministerstva vnitra ČR (ZPMV)213 - Revírní bratrská pokladna, zdrav. pojišťovna (RBP) E-mail (Required) Phone Donor identification number (Required) Please, provide information about organ recipient. 11 + 3 = Submit We’re here for you Contact Us
