Formulário de registo no programa de colheita de plasma convalescente

Nome completo*
Data de nascimento*
Morada*
Código Postal*
Localidade*
Contacto telefónico*
+351
  • Afghanistan +93
  • Albania +355
  • Algeria +213
  • American Samoa +1
  • Andorra +376
  • Angola +244
  • Anguilla +1
  • Antigua and Barbuda +1
  • Argentina +54
  • Armenia +374
  • Aruba +297
  • Australia +61
  • Austria +43
  • Azerbaijan +994
  • Bahamas +1
  • Bahrain +973
  • Bangladesh +880
  • Barbados +1
  • Belarus +375
  • Belgium +32
  • Belize +501
  • Benin +229
  • Bermuda +1
  • Bhutan +975
  • Bolivia +591
  • Bosnia and Herzegovina +387
  • Botswana +267
  • Brazil +55
  • British Indian Ocean Territory +246
  • British Virgin Islands +1
  • Brunei +673
  • Bulgaria +359
  • Burkina Faso +226
  • Burundi +257
  • Cambodia +855
  • Cameroon +237
  • Canada +1
  • Cape Verde +238
  • Caribbean Netherlands +599
  • Cayman Islands +1
  • Central African Republic +236
  • Chad +235
  • Chile +56
  • China +86
  • Christmas Island +61
  • Cocos +61
  • Colombia +57
  • Comoros +269
  • Congo - Kinshasa +243
  • Congo - Brazzaville +242
  • Cook Islands +682
  • Costa Rica +506
  • Côte d’Ivoire +225
  • Croatia +385
  • Cuba +53
  • Curaçao +599
  • Cyprus +357
  • Czech Republic +420
  • Denmark +45
  • Djibouti +253
  • Dominica +1
  • Dominican Republic +1
  • Ecuador +593
  • Egypt +20
  • El Salvador +503
  • Equatorial Guinea +240
  • Eritrea +291
  • Estonia +372
  • Ethiopia +251
  • Falkland Islands +500
  • Faroe Islands +298
  • Fiji +679
  • Finland +358
  • France +33
  • French Guiana +594
  • French Polynesia +689
  • Gabon +241
  • Gambia +220
  • Georgia +995
  • Germany +49
  • Ghana +233
  • Gibraltar +350
  • Greece +30
  • Greenland +299
  • Grenada +1
  • Guadeloupe +590
  • Guam +1
  • Guatemala +502
  • Guernsey +44
  • Guinea +224
  • Guinea-Bissau +245
  • Guyana +592
  • Haiti +509
  • Honduras +504
  • Hong Kong +852
  • Hungary +36
  • Iceland +354
  • India +91
  • Indonesia +62
  • Iran +98
  • Iraq +964
  • Ireland +353
  • Isle of Man +44
  • Israel +972
  • Italy +39
  • Jamaica +1
  • Japan +81
  • Jersey +44
  • Jordan +962
  • Kazakhstan +7
  • Kenya +254
  • Kiribati +686
  • Kosovo +383
  • Kuwait +965
  • Kyrgyzstan +996
  • Laos +856
  • Latvia +371
  • Lebanon +961
  • Lesotho +266
  • Liberia +231
  • Libya +218
  • Liechtenstein +423
  • Lithuania +370
  • Luxembourg +352
  • Macau +853
  • Macedonia +389
  • Madagascar +261
  • Malawi +265
  • Malaysia +60
  • Maldives +960
  • Mali +223
  • Malta +356
  • Marshall Islands +692
  • Martinique +596
  • Mauritania +222
  • Mauritius +230
  • Mayotte +262
  • Mexico +52
  • Micronesia +691
  • Moldova +373
  • Monaco +377
  • Mongolia +976
  • Montenegro +382
  • Montserrat +1
  • Morocco +212
  • Mozambique +258
  • Myanmar +95
  • Namibia +264
  • Nauru +674
  • Nepal +977
  • Netherlands +31
  • New Caledonia +687
  • New Zealand +64
  • Nicaragua +505
  • Niger +227
  • Nigeria +234
  • Niue +683
  • Norfolk Island +672
  • North Korea +850
  • Northern Mariana Islands +1
  • Norway +47
  • Oman +968
  • Pakistan +92
  • Palau +680
  • Palestine +970
  • Panama +507
  • Papua New Guinea +675
  • Paraguay +595
  • Peru +51
  • Philippines +63
  • Poland +48
  • Portugal +351
  • Puerto Rico +1
  • Qatar +974
  • Réunion +262
  • Romania +40
  • Russia +7
  • Rwanda +250
  • Saint Barthélemy +590
  • Saint Helena +290
  • Saint Kitts and Nevis +1
  • Saint Lucia +1
  • Saint Martin +590
  • Saint Pierre and Miquelon +508
  • Saint Vincent and the Grenadines +1
  • Samoa +685
  • San Marino +378
  • São Tomé and Príncipe +239
  • Saudi Arabia +966
  • Senegal +221
  • Serbia +381
  • Seychelles +248
  • Sierra Leone +232
  • Singapore +65
  • Sint Maarten +1
  • Slovakia +421
  • Slovenia +386
  • Solomon Islands +677
  • Somalia +252
  • South Africa +27
  • South Korea +82
  • South Sudan +211
  • Spain +34
  • Sri Lanka +94
  • Sudan +249
  • Suriname +597
  • Svalbard and Jan Mayen +47
  • Swaziland +268
  • Sweden +46
  • Switzerland +41
  • Syria +963
  • Taiwan +886
  • Tajikistan +992
  • Tanzania +255
  • Thailand +66
  • Timor-Leste +670
  • Togo +228
  • Tokelau +690
  • Tonga +676
  • Trinidad and Tobago +1
  • Tunisia +216
  • Turkey +90
  • Turkmenistan +993
  • Turks and Caicos Islands +1
  • Tuvalu +688
  • U.S. Virgin Islands +1
  • Uganda +256
  • Ukraine +380
  • United Arab Emirates +971
  • United Kingdom +44
  • United States +1
  • Uruguay +598
  • Uzbekistan +998
  • Vanuatu +678
  • Vatican City +39
  • Venezuela +58
  • Vietnam +84
  • Wallis and Futuna +681
  • Western Sahara +212
  • Yemen +967
  • Zambia +260
  • Zimbabwe +263
  • Åland Islands +358
E-Mail*
Data início doença*
Data da 1 análise negativa*
Data da 2 análise negativa
Internamento*
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* - Campos de preenchimento obrigatório.

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