Modulo d'ordine
Aiuti alla mobilità per persone con disabilità
I campi del modulo con un asterisco (*) sono obbligatori!
RITIRO INDIRIZZO
Nome / istituzione*
Strada*
CAP / località*
Persona di contatto / Tel*
Indirizzo email*
INDIRIZZO DI FATTURAZIONE
Gleich wie die Abholadresse
Zurücksetzen
Nome*
Strada*
CAP / località*
Persona di contatto / Tel
INFORMAZIONI PER IL PAZIENTE
Paziente / Numero caso
Sig./Sig.ra.*
Sig.
Sig.ra.
Nome*
Reparto / stanza*
Data di nascita*
(Wählen Sie zunächst das Jahr, dann den Monat und schließlich den Tag aus.)
Centro di costo
Presta particolare attenzione
Paziente oltre i 90 kg
No
Sì
kg
Isolamento
No
Sì
TIPO DI TRASPORTO
Dire bugie
Semi-sdraiato
Nella tua sedia a rotelle
Con una sedia a rotelle (Handicap TAXI)
Non ho bisogno di niente
Scala rampante senza ascensore
Secondo assistente al trasporto
DEVE ESSERE PRESA IN TRASPORTO
Rollator
Bastoni da passeggio
Ossigeno
(l/min)
Infusione
Infusomat
Molti bagagli
Accompagnatore (parenti ecc.)
DATA DI TRASPORTO
Data di partenza*
Orario di partenza*
00:00
00:05
00:10
00:15
00:20
00:25
00:30
00:35
00:40
00:45
00:50
00:55
01:00
01:05
01:10
01:15
01:20
01:25
01:30
01:35
01:40
01:45
01:50
01:55
02:00
02:05
02:10
02:15
02:20
02:25
02:30
02:35
02:40
02:45
02:50
02:55
03:00
03:05
03:10
03:15
03:20
03:25
03:30
03:35
03:40
03:45
03:50
03:55
04:00
04:05
04:10
04:15
04:20
04:25
04:30
04:35
04:40
04:45
04:50
04:55
05:00
05:05
05:10
05:15
05:20
05:25
05:30
05:35
05:40
05:45
05:50
05:55
06:00
06:05
06:10
06:15
06:20
06:25
06:30
06:35
06:40
06:45
06:50
06:55
07:00
07:05
07:10
07:15
07:20
07:25
07:30
07:35
07:40
07:45
07:50
07:55
08:00
08:05
08:10
08:15
08:20
08:25
08:30
08:35
08:40
08:45
08:50
08:55
09:00
09:05
09:10
09:15
09:20
09:25
09:30
09:35
09:40
09:45
09:50
09:55
10:00
10:05
10:10
10:15
10:20
10:25
10:30
10:35
10:40
10:45
10:50
10:55
11:00
11:05
11:10
11:15
11:20
11:25
11:30
11:35
11:40
11:45
11:50
11:55
12:00
12:05
12:10
12:15
12:20
12:25
12:30
12:35
12:40
12:45
12:50
12:55
13:00
13:05
13:10
13:15
13:20
13:25
13:30
13:35
13:40
13:45
13:50
13:55
14:00
14:05
14:10
14:15
14:20
14:25
14:30
14:35
14:40
14:45
14:50
14:55
15:00
15:05
15:10
15:15
15:20
15:25
15:30
15:35
15:40
15:45
15:50
15:55
16:00
16:05
16:10
16:15
16:20
16:25
16:30
16:35
16:40
16:45
16:50
16:55
17:00
17:05
17:10
17:15
17:20
17:25
17:30
17:35
17:40
17:45
17:50
17:55
18:00
18:05
18:10
18:15
18:20
18:25
18:30
18:35
18:40
18:45
18:50
18:55
19:00
19:05
19:10
19:15
19:20
19:25
19:30
19:35
19:40
19:45
19:50
19:55
20:00
20:05
20:10
20:15
20:20
20:25
20:30
20:35
20:40
20:45
20:50
20:55
21:00
21:05
21:10
21:15
21:20
21:25
21:30
21:35
21:40
21:45
21:50
21:55
22:00
22:05
22:10
22:15
22:20
22:25
22:30
22:35
22:40
22:45
22:50
22:55
23:00
23:05
23:10
23:15
23:20
23:25
23:30
23:35
23:40
23:45
23:50
23:55
Destinazione/Via/Cap*
Scegli dall'elenco o inserisci manualmente
Rehakliniken/Krankenhäuser
Rehaklinik Bethesda Tschugg
aarReha Schinznach
aaReha Schinznach Standort Zofingen
Klinik Barmelweid
Privat-Klinik im Park
Reha Rheinfelden
Rehaklinik Bellikon
Salina Rehaklinik
ZURZACH Care Akutnahe Rehabilitation Baden
ZURZACH Care Rehaklinik Bad Zurzach
ZURZACH Care Rehaklinik Baden
ZURZACH Care Rehaklinik Baden-Dättwil
ZURZACH Care RehaPrivée
Kinder-Reha Schweiz
Rehab Basel
Schweizer Paraplegiker-Zentrum
Universitätsklinik Balgrist
Zürcher RehaZentrum Wald
Zürcher RehaZentrum Davos
Rehaklinik Zihlschlacht
Rehaklinik Dussnang
Klinik im Hof
Klinik Gais
Rehazentrum Valens
Rehazentrum Walenstadtberg
Rheinburg-Klinik Walzenhausen
Kantonsspital Baselland Bruderholz
Universitäts-Kinderspital beider Basel
Adullam Spital Basel
Adullam Spital Riehen
Bethesda Spital Basel
Clinique Le Noirmont
Felix-Platter-Spital
Hôpital du Jura, site de Porrentruy
ZURZACH Care Rehaklinik Basel
Berner Klinik Montana
Berner Reha Zentrum
Hôpital de Saint-Imier
Inselspital Bern
Klinik Schönberg
Klinik SGM Langenthal
Klinik Siloah
Rehaklinik Eden
Rehaklinik Hasliberg
Spital Belp
Spital Riggisberg
Spital Tiefenau
Spitalzentrum Biel
HFR Billens
HFR Meyriez-Murten
Cereneo - Zentrum für Neurologie und Rehabilitation
Luzerner Kantonsspital
Rehazentrum Wolhusen
ZURZACH Care Rehaklinik Sonnmatt Luzern
Klinik Adelheid
Luzerner Höhenklinik Montana
Rehaklinik Seewis
Zürcher RehaZentrum Wald
Zürcher RehaZentrum Davos
Spital Schwyz
Rehazentrum Walenstadtberg
ZURZACH Care Rehaklinik Braunwald
ZURZACH Care Rehaklinik Glarus
ZURZACH Care Rehaklinik Kilchberg
ZURZACH Care Rehaklinik Zollikerberg
Clinic Bad Ragaz
Alters und Pflegeheime Kanton Solothurn
Alters- und Pflegeheim Inseli
Alterszentren GAG
Spitex Thal Tagesstätte
Zentrum Leuenmatt
Alterszentrum Baumgarten
Alters- und Pflegeheim Heimetblick
Läbesgarte Bleichematt
Alterszentrum Breitenbach
Zentrum Passwang
Hospiz Solothurn
THARAD Zentrum für Pflege und Betreuung
Alters- Pflegewohngruppe Dornach
Alters- und Pflegeheim Wollmatt
Stiftung Haus Martin
Alters- und Pflegeheim Brüggli
Tagesstätte Sonnegg im Brüggli Park
Alterszentren GAG
Alterszentrum Mühlefeld
Pflegewohnheim Flühbach, Stiftung Blumenrain
Alters- und Pflegeheim Am Bach
Alterszentrum Am Weinberg
Alterszentrum Kastels
Institution Y-Psilon AG
Solviva Sunnepark Grenchen
Seniorenzentrum Untergäu
Tagesstätte Oase Dorneck
Alters- und Pflegeheim Ischimatt
Vorstädtli Generationenhaus
Alters- u. Pflegeheim Bad-Ammannsegg
Alterssitz Buechibärg
Betreuungs- und Pflegezentrum Schlossgarten
Alters- und Pflegeheim "Stäglen"
Alters- und Pflegeheim Bellevue
Oase Obergösgen
Alterszentren GAG
Alters- und Demenzzentrum St. Martin
Alters- und Pflegeheim Haus zur Heimat
Alters- und Pflegeheim Weingarten
Pflegeheim Stadtpark
Senevita Residenz Bornblick
Träffpunkt Ruttiger
Oepfelbaum Recherswil
Haus im Park
Alters- und Pflegeheim Thüringenhaus & St. Katharinen
Seraphisches Liebeswerk Solothurn
Demenz-Pflegezentrum Forst & Pflegezentrum Magnolienpark
Tertianum Residenz Sphinxmatte
Alterszentrum Wengistein
Tertianum Oasis
Alterszentrum Marienheim
Tertianum Brunnematt
Elisabethenheim
Stiftung Blumenfeld
Psychiatrische Dienste
Altersheime Region Oberaargaun
Lebensart Aarwangen
Altersheim Leimatt AG
Senioren-Pension Waldruhe
Alters- und Pflegeheim Bijou
dahlia oberaargau ag
Scheidegg Alterszentrum
Altersresidenz zur Wiese AG
dahlia Huttwil
FiechtenPark
Stiftung Sonnegg Huttwil
Spitex Oberes Langetental AG
St. Niklaus
Alterszentrum Haslibrunnen
Lindenhof Langenthal
Alterszentrum "am Dorfplatz"
Aktiva Wohnsiedlung
Alters- und Pflegeheim Schärme
Alterszentrum Jurablick
dahlia Niederbipp
Alterszentrum Spycher
Oberi Bäch
Alterszentrum Jurablick
Murhof Betreutes Wohnen & Pflege
Alterszentrum Moosmatt
Pflegeheim Sennhof AG
Altro (inserisci manualmente)
Destinazione*
Strada*
CAP / località*
Appuntamento - orario di arrivo*
00:00
00:05
00:10
00:15
00:20
00:25
00:30
00:35
00:40
00:45
00:50
00:55
01:00
01:05
01:10
01:15
01:20
01:25
01:30
01:35
01:40
01:45
01:50
01:55
02:00
02:05
02:10
02:15
02:20
02:25
02:30
02:35
02:40
02:45
02:50
02:55
03:00
03:05
03:10
03:15
03:20
03:25
03:30
03:35
03:40
03:45
03:50
03:55
04:00
04:05
04:10
04:15
04:20
04:25
04:30
04:35
04:40
04:45
04:50
04:55
05:00
05:05
05:10
05:15
05:20
05:25
05:30
05:35
05:40
05:45
05:50
05:55
06:00
06:05
06:10
06:15
06:20
06:25
06:30
06:35
06:40
06:45
06:50
06:55
07:00
07:05
07:10
07:15
07:20
07:25
07:30
07:35
07:40
07:45
07:50
07:55
08:00
08:05
08:10
08:15
08:20
08:25
08:30
08:35
08:40
08:45
08:50
08:55
09:00
09:05
09:10
09:15
09:20
09:25
09:30
09:35
09:40
09:45
09:50
09:55
10:00
10:05
10:10
10:15
10:20
10:25
10:30
10:35
10:40
10:45
10:50
10:55
11:00
11:05
11:10
11:15
11:20
11:25
11:30
11:35
11:40
11:45
11:50
11:55
12:00
12:05
12:10
12:15
12:20
12:25
12:30
12:35
12:40
12:45
12:50
12:55
13:00
13:05
13:10
13:15
13:20
13:25
13:30
13:35
13:40
13:45
13:50
13:55
14:00
14:05
14:10
14:15
14:20
14:25
14:30
14:35
14:40
14:45
14:50
14:55
15:00
15:05
15:10
15:15
15:20
15:25
15:30
15:35
15:40
15:45
15:50
15:55
16:00
16:05
16:10
16:15
16:20
16:25
16:30
16:35
16:40
16:45
16:50
16:55
17:00
17:05
17:10
17:15
17:20
17:25
17:30
17:35
17:40
17:45
17:50
17:55
18:00
18:05
18:10
18:15
18:20
18:25
18:30
18:35
18:40
18:45
18:50
18:55
19:00
19:05
19:10
19:15
19:20
19:25
19:30
19:35
19:40
19:45
19:50
19:55
20:00
20:05
20:10
20:15
20:20
20:25
20:30
20:35
20:40
20:45
20:50
20:55
21:00
21:05
21:10
21:15
21:20
21:25
21:30
21:35
21:40
21:45
21:50
21:55
22:00
22:05
22:10
22:15
22:20
22:25
22:30
22:35
22:40
22:45
22:50
22:55
23:00
23:05
23:10
23:15
23:20
23:25
23:30
23:35
23:40
23:45
23:50
23:55
Dipartimento
Telefono
Viaggio di ritorno
No
Sì
Data di ritorno
Tempo di ritorno
00:00
00:05
00:10
00:15
00:20
00:25
00:30
00:35
00:40
00:45
00:50
00:55
01:00
01:05
01:10
01:15
01:20
01:25
01:30
01:35
01:40
01:45
01:50
01:55
02:00
02:05
02:10
02:15
02:20
02:25
02:30
02:35
02:40
02:45
02:50
02:55
03:00
03:05
03:10
03:15
03:20
03:25
03:30
03:35
03:40
03:45
03:50
03:55
04:00
04:05
04:10
04:15
04:20
04:25
04:30
04:35
04:40
04:45
04:50
04:55
05:00
05:05
05:10
05:15
05:20
05:25
05:30
05:35
05:40
05:45
05:50
05:55
06:00
06:05
06:10
06:15
06:20
06:25
06:30
06:35
06:40
06:45
06:50
06:55
07:00
07:05
07:10
07:15
07:20
07:25
07:30
07:35
07:40
07:45
07:50
07:55
08:00
08:05
08:10
08:15
08:20
08:25
08:30
08:35
08:40
08:45
08:50
08:55
09:00
09:05
09:10
09:15
09:20
09:25
09:30
09:35
09:40
09:45
09:50
09:55
10:00
10:05
10:10
10:15
10:20
10:25
10:30
10:35
10:40
10:45
10:50
10:55
11:00
11:05
11:10
11:15
11:20
11:25
11:30
11:35
11:40
11:45
11:50
11:55
12:00
12:05
12:10
12:15
12:20
12:25
12:30
12:35
12:40
12:45
12:50
12:55
13:00
13:05
13:10
13:15
13:20
13:25
13:30
13:35
13:40
13:45
13:50
13:55
14:00
14:05
14:10
14:15
14:20
14:25
14:30
14:35
14:40
14:45
14:50
14:55
15:00
15:05
15:10
15:15
15:20
15:25
15:30
15:35
15:40
15:45
15:50
15:55
16:00
16:05
16:10
16:15
16:20
16:25
16:30
16:35
16:40
16:45
16:50
16:55
17:00
17:05
17:10
17:15
17:20
17:25
17:30
17:35
17:40
17:45
17:50
17:55
18:00
18:05
18:10
18:15
18:20
18:25
18:30
18:35
18:40
18:45
18:50
18:55
19:00
19:05
19:10
19:15
19:20
19:25
19:30
19:35
19:40
19:45
19:50
19:55
20:00
20:05
20:10
20:15
20:20
20:25
20:30
20:35
20:40
20:45
20:50
20:55
21:00
21:05
21:10
21:15
21:20
21:25
21:30
21:35
21:40
21:45
21:50
21:55
22:00
22:05
22:10
22:15
22:20
22:25
22:30
22:35
22:40
22:45
22:50
22:55
23:00
23:05
23:10
23:15
23:20
23:25
23:30
23:35
23:40
23:45
23:50
23:55
Handicap Taxi 2020.
