New Project Questionnaire Land-based Hospital

Thank you for your trust in Worldwide Hospitals. We are glad to help you with your project. To proceed with your request, please fill out this form. It consists of 13 sections. We invite you to read our fields carefully. Please have beforehand all documents as a separate PDF or JPG format to justify the site to your hospital and your identity (ID).

Please note that your personal data will not be provided to third parties and I am making a formal request for a proposal.

If you have any questions, notes, or comments regarding this questionnaire, please do not hesitate to contact us. You can reach us by email at wwh@wwh.com, by telephone of 0049 40 51459 0 in our working hours from Monday to Friday between 08:30 – 17:30 hours (UTC/GMT +2), or by mail at our Headquarters North, in Sportallee 1, 22335, Hamburg, Germany.

SECTION I: ORGANIZATION

SECTION II: CONTACT INFORMATION

SECTION III: ATTACHMENTS

SECTION IV: SITE INFORMATION

SECTION V: GENERAL DESCRIPTION OF THE HOSPITAL

SECTION VI: SCOPE OF MEDICAL SERVICES

Mark all the medical functional areas to be included in your plan. Please note that, if you have marked one main department (marked in capital letters) as “no”, you cannot include the sub-areas.

SECTION VII: SCOPE OF SUPPORT SERVICES

SECTION VIII: PATIENT CAPACITY

Please write down the amount of patients of each type, that the hospital should accommodate on a DAILY basis (if known).

SECTION IX: PATIENT ACCESS

SECTION X: HOSPITAL STAFF

Mark all the staffing services to be included in your hospital plan:

SECTION XI: IMPORT OPERATIONS

LOGISTIC OPERATIONS Please answer the following questions:

SECTION XII: MISCELLANEOUS AND COMMENTS

Please add all the remarks, questions or comments you have for this project:

SIGNATURE