Contact page | PIO

Information
Phone: 021383050
You can obtain all information on weekdays from 8:00 AM to 4:00 PM at: 021383050
Email: [email protected]
Visits:
Mon, Wed, Fri (10:00 AM - 1:00 PM)
Tue, Thu, Sat, Sun (3:00 PM - 5:00 PM)
By prior arrangement at 021383050
New User Registration
Phone: 021383050
Email: [email protected]
Registration via online form
Director
Anela Hrkać
Email: [email protected]
Social Worker
Tanja Penava
Email: [email protected]
Phone: 021383050
Head Nurse
Marija tudor
Email: [email protected]
Social networks
- Facebook
- Instagram

Request for Accommodation in the Home

Personal information (person being placed in a home)

DOCUMENTATION REQUIRED FOR SUBMITTING A REQUEST

Request for accommodation
Statement of payment certified by a notary public
Doctor's opinion/certificate
Copy of the birth certificate
Copy of the ID card
Copy of the health insurance and supplemental health insurance card

PERSONAL DATA (of the person liable for payment - responsible person for the user)

Name and surname

Email

Date of birth

Place of birth

Home address

OIB or JMBG

Relationship to the user

Phone number

PERSONAL DATA (of the person being placed in the home)

First name and last name

Date of birth

Residence

OIB or JMBG

Current health condition

Medical diagnoses

Documentation

Here you can attach medical documentation (doctor's opinion/confirmation or the latest discharge letter if the user possesses it).

Maximum 5 files.
8 MB limit.
Allowed types: jpg, jpeg, png, pdf, doc, docx, ppt, pptx, rar, zip.

Reasons for accommodation

Brief description of the person being placed in the home

DOCUMENTATION REQUIRED FOR SUBMITTING A REQUEST

Request for accommodation

One file only.
8 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Statement of payment (original required upon moving in)

One file only.
8 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Doctor's opinion/certificate

One file only.
8 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Copy of the birth certificate

One file only.
8 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Copy of the ID card

One file only.
8 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Copy of the health insurance and supplemental health insurance card

One file only.
8 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Copy of the ID card of the person liable for payment

One file only.
8 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Other

One file only.
8 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

I agree

By using this form, you agree that you are familiar with the privacy rules and accept the collection and processing of personal data provided in the form, without which your request in the form cannot be fulfilled.