Book Electrical cardioversion
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Book Electrical cardioversion

Phone (from 8.30 am to 4.30 pm): +41 91 640 40 40

Email: segretariato.cardioticino@hin.ch

Request form

Download the form, fill it in and attach it below.

Download the form (PDF)
If you are a physician, you can enter your GLN number. Secretaries may leave it empty.
Online form

Fill in the request

Fill in the fields below: at the end you download the PDF form already filled in, identical to the original, ready to attach to the email for the secretariat.

Request
Patient data

The original PDF has no box for the First name: there is only the dotted line. Write first and last name together in the field Last name, or add the first name by hand on the printed form.

Indication
Therapy
Information

In the PDF, the Yes / No boxes of these three lines are not real checkboxes. The tick counts as “yes”; if the answer is no, leave it empty.

To attach

“ECG and heart rate” is listed in the PDF but has no checkbox: attach it anyway.

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Centro Cardiologico Ticino, Via Pretorio 9, 6900 Lugano
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