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Please Note: In order for AJCH to efficiently manage your referral, this form must be fully completed and along with all requested documentation. All referrals will be dealt with between the hours of 09:00 -14:00 Sun- Thurs.

Referring Physician Details
Patient Details
Male Female
Parent/Guardian Details

Clinical Signs Haematology Time Biochemistry Time
Urea:

ART VENCAP

Fluids Drugs

Al Jalila Children's Specialty Hospital

Al Jaddaf - Dubai United Arab Emirates

800 AJCH (8002524)