Forms

Headquarter in Siracusa

Forms to request the palliative care service

Request form to activate the palliative care service
Assessment form to activate the palliative care service
Palliative performance scale (PPS) and Palliative prognostic index (PPI)
Request form to select an accredited association providing home palliative care

Activation request

In the “Forms” section you can read and/or print out the prescribed application forms.

Forms

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PRIVACY & COOKIES POLICY

OPENING HOURS

  • Monday - Friday: 8:00 am - 8:00 pm
  • Saturday: 8:00 am - 1:00 pm

RAGUSA

  • Via Mariano Rumor, 10
  • Tel 0932.227901

SIRACUSA

  • Viale Santa Panagia, 141
  • Tel 0931.759822

TRAPANI

  • Via Orti, 118
  • Tel 0923.593571

Associazione SAMOT Ragusa Onlus – Struttura accreditata in conformità al D.A. n. 2280/11 notificata dal competente Assessorato Regionale alla Salute con D.D.G. n. 942 del 16 Maggio 2013.
C.F./P.I. 01168400883

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