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Formulir Permintaan Relawan Merah Donor Darah
Hai orang baik!
Anda butuh darah? Klik
https://forms.gle/3LoD4MnAVCF9NMUb7
KOMUNITAS RELAWAN MERAH adalah sebuah komunitas sukarelawan pendonor yang siap sedia membantu bagi sesama yang sedang membutuhkan donor darah
https://t.me/relawanmerah
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Email
*
Your email
Area
*
Your answer
Tanggal
*
MM
/
DD
/
YYYY
Nama pasien
*
Your answer
Golongan darah
*
A+ (A Rhesus Positif)
B+ (B Rhesus Positif)
AB+ (AB Rhesus Positif)
O+ (O Rhesus Positif)
A- (A Rhesus Negatif)
B- (B Rhesus Negatif)
AB- (AB Rhesus Negatif)
O- (O Rhesus Negatif)
Other:
Jumlah pendonor
*
Your answer
Jenis donor
*
Whole Blood (Donor Darah Biasa)
Apheresis
Other:
Rumah Sakit
*
Your answer
Narahubung
*
Your answer
HP
*
Your answer
Keterangan
Your answer
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