Yakın Doğu Üniversite Hastanesi
PCR/ANTIGEN Testi Başvuru Formu | PCR/ANTIGEN Test Application Form
KİMLİK NO
/ PASSPORT NO
UYRUK
/ NATIONALITY
*
---------
KKTC / TRNC
TÜRKİYE / TURKEY
AMERİKA BİRLEŞİK DEVLETLERİ (A.B.D.) / UNITED STATES OF AMERICA (U.S.A.)
AFGANİSTAN / AFGHANISTAN
ALMANYA / GERMANY
AMERİKA KÜÇÜK OUT. ADALARI / US MINOR OUTLYING ISLANDS
AMERİKAN SAMOA / AMERICAN SAMOA
ANDORRA / ANDORRA
ANGOLA / ANGOLA
ANGUİLLA / ANGUİLLA
ANTARTİKA / ANTARCTICA
ANTİGUA-BARBUDA / ANTIGUA-BARBUDA
ARJANTİN / ARGENTINA
ARNAVUTLUK / ALBANIA
ARUBA / ARUBA
AVUSTRALYA / AUSTRALIA
AVUSTURYA / AUSTRIA
AZERBAYCAN-NAHÇ. / AZERBAIJAN
BAHAMALAR / BAHAMAS
BAHREYN / BAHRAIN
BANGLADEŞ / BANGLADESH
BARBADOS / BARBADOS
BATI TİMOR / TIMOR-LESTE
BELÇİKA / BELGIUM
BELİZE / BELIZE
BENİN / BENIN
BERMUDA / BERMUDA
BEYAZ RUSYA / BELARUS
BHUTAN / BHUTAN
BİRLEŞİK ARAP EMİRLİKLERİ / UNITED ARAB EMIRATES
BOLİVYA / BOLIVIA
BOSNA HERSEK / BOSNIA & HERZEGOVINA
BOTSVANA / BOTSWANA
BOUVET ADASI / BOUVET ISLAND
BREZİLYA / BRAZIL
BRUNEİ / BRUNEI DARRUSSALAM
BULGARİSTAN / BULGARIA
BURKİNA FASO / BURKINA FASO
BURMA (BİRMANYA) / MYANMAR
BURUNDİ / BURUNDI
CAPE VERDE / CAPE VERDE
CAYMAN ADALARI / CAYMAN ISLANDS
CEBELİTARIK / GIBRALTAR
CEUTA / CEUTA
CEZAYİR / ALGERIA
CİBUTİ / DJIBOUTI
COCOS ADALARI / COCOS ISLANDS
COOK ADASI / COOK ISLAND
ÇAD / CHAD
ÇEK CUMHURİYETİ / CZECH REPUBLIC
ÇİN HALK CUMHUR. / CHINA, PEOPLE'S REPUBLIC OF
DANİMARKA / DENMARK
DOMİNİK CUMHUR. / DOMINICAN REPUBLIC
DOMİNİKA / DOMINICA
EKVATOR / ECUADOR
EKVATOR GİNESİ / EQUATORIAL GUINEA
EL SALVADOR / EL SALVADOR
ENDONEZYA / INDONESIA
ERİTRE / ERITREA
ERMENİSTAN / ARMENIA
ESTONYA / ESTONIA
ETİYOPYA / ETHIOPIA
FALKLAND ADALARI / FALKLAND ISLANDS
FAROE ADALARI / FAROE ISLANDS
FAS / MOROCCO
FİJİ / FIJI
FİLDİŞİ SAHİLİ / CÔTE d'IVORIE
FİLİPİNLER / PHILIPPINES
FİNLANDİYA / FINLAND
FRANSA / FRANCE
FRANSA GÜNEY BÖLGELERİ / FRENCH SOUTHERN TERRITORIES
FRANSIZ POLİNEZYASI / FRENCH POLYNESIA
GABON / GABON
GAMBİYA / GAMBIA
GANA / GHANA
GİNE / GUINEA
GİNE-BİSSAU / GUINEA-BISSAU
GRENADA / GRENADA
GRÖNLAND / GREENLAND
GUAM / GUAM
GUATEMALA / GUATEMALA
GUYANA / GUYANA
GÜNEY AFRİKA CUM. / SOUTH AFRİCA REPUBLIC
GÜNEY GEORGİA VE GÜNEY SANDWICH ADALARI / SOUTH GEORGIA & SOUTH SANDWICH ISLANDS
GÜNEY KORE CUM. / KOREA, REPUBLIC OF
GÜRCİSTAN / GEORGIA
HAİTİ / HAITI
HEARD ADALAI VE MC DONALD ADASI / HEARD ISLAND & Mc DONALD ISLAND
HIRVATİSTAN / CROATIA
HİNDİSTAN / INDIA
HOLLANDA / NETHERLANDS
HOLLANDA ANTİLLERİ / NETHERLANDS ANTİLLES
HONDURAS / HONDURAS
HONG-KONG / HONG KONG
IRAK / IRAQ
İNGİLİZ HİNT OKYANUSU TOPRAKLARI / BRITISH INDIAN OCEAN TERRITORY
İNGİLİZ VİRGİN ADALARI / BRITISH VIRGIN ISLANDS
İNGİLTERE / UNITED KINGDOM
İRAN / IRAN
İRLANDA / IRELAND
İSPANYA / SPAIN
İSRAİL / ISRAEL
İSVEÇ / SWEDEN
İSVİÇRE / SWITZERLAND
FİLİSTİN / PALESTINE
İTALYA / ITALY
İZLANDA / ICELAND
JAMAİKA / JAMAICA
JAPONYA / JAPAN
KAMBOÇYA / CAMBODIA
KAMERUN / CAMEROON
KANADA / CANADA
KARADAĞ / MONTENEGRO
KATAR / QATAR
KAZAKİSTAN / KAZAKHISTAN
KENYA / KENYA
KIBRIS RUM KES. / SOUTH CYPRUS
KIRGIZİSTAN / KYRGYZSTAN
KİRİBATİ / KIRIBATI
KOLOMBİYA / COLOMBIA
KOMORLAR / COMOROS
KONGO / CONGO
DEMOKRATİK KONGO CUMHURİYETİ / DEMOCRATIC REPUBLIC OF CONGO
KOSOVA / KOSOVO
KOSTA RİKA / COSTA RICA
KRİSMIS ADALARI / CHRISTMAS ISLANDS
KUVEYT / KUWAIT
KUZEY KORE / SOUTH KOREA
KUZEY MARİANA ADALARI / NORTH MARIANA ISLANDS
KÜBA / CUBA
LAOS DEMOK.HALK C / LAO PEOPLE'S DEMOCRATIC REPUBLIC
LESOTO / LESOTHO
LETONYA / LATVIA
LIECHTENSTEIN / LIECHTENSTEIN
LİBERYA / LIBERIA
LİBYA / LIBYA
LİTVANYA / LITHUANIA
LÜBNAN / LEBANON
LÜKSEMBURG / LUXEMBOURG
MACARİSTAN / HUNGARY
MADAGASKAR / MADAGASCAR
MAKAO / MACAO
MAKEDONYA / MACEDONIA
MALAVİ / MALAWI
MALDİVLER / MALDIVES
MALEZYA / MALAYSIA
MALİ / MALI
MALTA / MALTA
MARSHAL ADALARI / MASHALL ISLANDS
MAURİTİUS / MAURITIUS
MAYOTTE / MAYOTTE
MEKSİKA / MEXICO
MELİLLA / MELİLLA
MISIR / EGYPT
MİKRONEZYA / MICRONESIA
MOĞOLİSTAN / MONGOLIA
MOLDOVYA / MOLDOVA
MONTSERRAT / MONTSERRAT
MORİTANYA / MAURITANIA
MOZAMBİK / MOZAMBIQUE
NAMİBYA / NAMIBIA
NAURU / NAURU
NEPAL / NEPAL
NIUE ADASI / NIUE ISLAND
NİJER / NIGER
NİJERYA / NIGERIA
NİKARAGUA / NICARAGUA
NORFOLK ADASI / NORFOLK ISLAND
NORVEÇ / NORWAY
ORTA AFRİKA CUMHURİYETİ / CENTRAL AFRICAN REPUBLIC
ÖZBEKİSTAN / UZBEKISTAN
PAKİSTAN / PAKISTAN
PALAU / PALAU
PANAMA / PANAMA
PAPUA (YENİ GİNE) / PAPUA NEW GUINEA
PARAGUAY / PARAGUAY
PERU / PERU
PİTCAİRN / PITCAIRN
POLONYA / POLAND
PORTEKİZ / PORTUGAL
ROMANYA / ROMANIA
RUANDA / RWANDA
RUSYA FEDERASYONU / RUSSIAN FEDERATION
SAMOA / SAMOA
SAN MARİNO / SAN MARINO
SAO TOME VE PRIN. / SAO TOME & PRINCIPE
SENEGAL / SENEGAL
SEYŞELLER / SEYCHELLES
SIRBİSTAN / SERBIA
SİERRA LEONE / SIERRA LEONE
SİNGAPUR / SINGAPORE
SLOVAKYA / SLOVAKIA
SLOVENYA / SLOVENIA
SOLOMON ADALARI / SOLOMON ISLANDS
SOMALİ / SOMALIA
SRİ LANKA / SRI LANKA
ST. HELENA / SAINT HELENA
ST. KITTS VE NEVİS / SAINT KITTS & NEVIS
ST. PIERRE & MIQUELON / ST. PIERRE & MIQUELON
ST.LUCİA / ST. LUCIA
SUDAN / SUDAN
SURİNAM / SURINAME
SURİYE / SYRIA
SUUDİ ARABİSTAN / SAUDI ARABIA
SVAZİLAND / SWAZILAND
ŞİLİ / CHILE
TACİKİSTAN / TAJIKISTAN
TANZANYA / TANZANIA
TAYLAND / THAILAND
TAYVAN / TAIWAN
TOGO / TOGO
TOKELAU / TOKELAU
TONGA / TONGA
TRİNİDAD VE TOBAGO / TRINIDAD & TOBAGO
TUNUS / TUNISIA
TURKS VE CAİCAOS ADALARI / TURKS & CAICOS ISLANDS
TUVALU / TUVALU
TÜRKMENİSTAN / TURKMENISTAN
UGANDA / UGANDA
UKRAYNA / UKRAINE
UMMAN / OMAN
URUGUAY / URUGUAY
ÜRDÜN / JORDAN
VANUATU / VANUATU
VENEZUELLA / VENEZUELA
VİETNAM / VIETNAM
WALLİS VE FUTUNA / WALLIS & FUTUNA
YEMEN / YEMEN
YENİ KALEDONYA / NEW CALEDONIA
YENİ ZELANDA / NEW ZEALAND
YUNANİSTAN / GREECE
ZAMBİYA / ZAMBIA
ZİMBABVE / ZIMBABWE
ADI
/ GIVEN NAME
*
SOYADI
/ FAMILY NAME
*
DOĞUM TARİHİ
/ BIRTHDATE
*
CİNSİYET
/ GENDER
*
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KADIN
ERKEK
ADRES
/ ADDRESS
*
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LEFKOSA
GIRNE
MAGUSA
GUZELYURT
LEFKE
ISKELE
TELEFON NUMARASI
/ PHONE NUMBER
*
Captcha
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