照顾者签证信息搜集表 ( Bupa申请) 被照顾者基本信息姓必填项！必填项！名必填项！必填项！电子邮箱必填项！必填项！性别男性女性必填项！必填项！出生日期必填项！必填项！入境澳洲时间必填项！必填项！联系电话必填项！必填项！手机号码必填项！必填项！居住地址...必填项！必填项！- 国家 -Åland IslandsAfghanistanAlbaniaAlgeriaAmerican Samoa (US)AndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermuda (UK)BhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurma (Myanmar)BurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook Islands (NZ)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (UK)Faroe Islands (Denmark)FijiFinlandFranceFrench GuianaFrench Polynesia (France)GabonGambiaGeorgiaGermanyGhanaGibraltar (UK)GreeceGreenland (Denmark)GrenadaGuam (US)GuatemalaGuernsey (UK)GuineaGuinea-BissauGuyanaHaitiHondurasHong Kong (China)HungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of Man (UK)IsraelItalyIvory CoastJamaicaJapanJersey (UK)JordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau (China)MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMayotte (France)MexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew Caledonia (France)New ZealandNicaraguaNigerNigeriaNiue (NZ)Norfolk Island (Australia)Northern Mariana Islands (US)NorwayOmanPakistanPalauPalestinian territoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn Islands (UK)PolandPortugalQatarRéunion (France)RomaniaRussian FederationRwandaSão Tomé and PríncipeSaint Helena, Ascension and Tristan da Cunha (UK)Saint Kitts and NevisSaint LuciaSaint Pierre and Miquelon (France)Saint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen (Norway)SwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelau (NZ)TongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna (France)Western SaharaYemenZambiaZimbabwe- 国家 -必填项！必填项！城市必填项！必填项！邮编必填项！必填项！您是否曾经做过照顾者签证申请的体检？是否必填项！必填项！具体日期[{"f":"option_6","l":"equal","v":"Yes","fa":"","va":""}]必填项！必填项！照顾者信息 姓必填项！必填项！名必填项！必填项！出生日期必填项！必填项！- 居住国 -Åland IslandsAfghanistanAlbaniaAlgeriaAmerican Samoa (US)AndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermuda (UK)BhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurma (Myanmar)BurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook Islands (NZ)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (UK)Faroe Islands (Denmark)FijiFinlandFranceFrench GuianaFrench Polynesia (France)GabonGambiaGeorgiaGermanyGhanaGibraltar (UK)GreeceGreenland (Denmark)GrenadaGuam (US)GuatemalaGuernsey (UK)GuineaGuinea-BissauGuyanaHaitiHondurasHong Kong (China)HungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of Man (UK)IsraelItalyIvory CoastJamaicaJapanJersey (UK)JordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau (China)MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMayotte (France)MexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew Caledonia (France)New ZealandNicaraguaNigerNigeriaNiue (NZ)Norfolk Island (Australia)Northern Mariana Islands (US)NorwayOmanPakistanPalauPalestinian territoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn Islands (UK)PolandPortugalQatarRéunion (France)RomaniaRussian FederationRwandaSão Tomé and PríncipeSaint Helena, Ascension and Tristan da Cunha (UK)Saint Kitts and NevisSaint LuciaSaint Pierre and Miquelon (France)Saint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen (Norway)SwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelau (NZ)TongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna (France)Western SaharaYemenZambiaZimbabwe- 居住国 -必填项！必填项！与被照顾者关系？必填项！必填项！列出所有将与照顾者一起来的人（例如：其他一起移居的家庭成员）姓名必填项！必填项！关系必填项！必填项！是否已经向移民局递交了照顾者签证申请？是否必填项！必填项！收据号[{"f":"field_TRfCZ","l":"equal","v":"Yes","fa":"","va":""}]必填项！必填项！日期[{"f":"field_TRfCZ","l":"equal","v":"Yes","fa":"","va":""}]必填项！必填项！被照顾者目前情况你目前的身体状况是怎么样的？请进行简单描述必填项！必填项！导致被照顾者需要别人照料的主要的身体原因？必填项！必填项！目前是谁在帮助照料？列出他/他们的名字、年龄、与被照顾者关系。姓名必填项！必填项！年龄必填项！必填项！关系必填项！必填项！是否需要以下方面的照顾？泡澡和淋浴 （例如，清洗、帮助进出浴缸或淋浴）如厕 （例如，帮助上下厕所，清理尿失禁）穿衣、脱衣服和打扮 （例如，理发、剃须、牙齿护理、拉链或纽扣帮助、抽屉/衣柜帮助、假肢安装）吃饭 （例如：协助喂食和烹饪，拿着吸管，切碎食物，准备特殊饮食）行动能力 （例如：行走、推轮椅、协助爬楼梯、上下床或转弯）特殊运动疗法由于残疾须出行 （例如：去物理治疗、去医院）准备或监督药物治疗 （例如：消毒设备、更换敷料、护理假肢）必填项！必填项！每天需要提供泡澡和淋浴帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option}","l":"contains","v":"1","fa":"","va":""}]必填项！必填项！每天需要提供如厕帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option}","l":"contains","v":"2","fa":"","va":""}]必填项！必填项！每天需要提供穿衣、脱衣服和打扮帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option}","l":"contains","v":"3","fa":"","va":""}]必填项！必填项！每天需要提供吃饭帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option}","l":"contains","v":"4","fa":"","va":""}]必填项！必填项！每天需要提供行动能力帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option}","l":"contains","v":"5","fa":"","va":""}]必填项！必填项！每天需要提供特殊运动疗法帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option}","l":"contains","v":"6","fa":"","va":""}]必填项！必填项！每天需要提供由于残疾须出行帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option}","l":"contains","v":"7","fa":"","va":""}]必填项！必填项！每天需要提供准备或监督药物治疗帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option}","l":"contains","v":"8","fa":"","va":""}]必填项！必填项！以下方面是否需要持续监督？监控/监督-夜间 （例如，定时服用药物，确保您不会迷路监控/监督–白天 （例如，确保您不会走失，确保燃气/炉子/水龙头关闭，防止其他不安全行为）必填项！必填项！每天需要提供监控/监督-夜间帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option_2}","l":"contains","v":"1","fa":"","va":""}]必填项！必填项！每天需要提供监控/监督–白天帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option_2}","l":"contains","v":"2","fa":"","va":""}]必填项！必填项！是否需要的其他协助或监督?是否必填项！必填项！请填写您所需要的其他协助或监督...必填项！必填项！每天需要提供此类帮助的时间少于30分钟30-60分钟60-120分钟超过120分钟[{"f":"{option_2}","l":"equal","v":"2","fa":"","va":""}]必填项！必填项！[{"f":"option_3","l":"equal","v":"Yes","fa":"","va":""}]你目前的帮助安排是什么？谁照顾你？ 多久？ 多长时间？必填项！必填项！你经常看病的医生是谁？医生姓名必填项！必填项！医生地址必填项！必填项！医生联系方式必填项！必填项！是否有专家或其他医生/专家为您治疗您的疾病/残疾？是否必填项！必填项！专家姓名必填项！必填项！专家地址必填项！必填项！最近一次访问时间必填项！必填项！您接受治疗的病症是什么？必填项！必填项！如果您需要提供更多信息，请在此处填写必填项！必填项！[{"f":"option_4","l":"equal","v":"Yes","fa":"","va":""}]有没有其他人可以告诉我们您的任何疾病/残疾？（例如：心理学家、物理治疗师、辅导员、社区工作者）是否必填项！必填项！专业人员姓名必填项！必填项！专业人员职业必填项！必填项！专业人员地址必填项！必填项！专业人员联系方式必填项！必填项！如果您需要提供更多信息，请在此处填写必填项！必填项！[{"f":"field_bJSQz","l":"equal","v":"Yes","fa":"","va":""}]您是否曾因这些疾病/残疾入院治疗？是否必填项！必填项！最后入院日期必填项！必填项！出院日期必填项！必填项！医院名称必填项！必填项！入院理由（如手术、检查、治疗）必填项！必填项！过去5年入院次数？必填项！必填项！[{"f":"field_aCgaO","l":"equal","v":"Yes","fa":"","va":""}]您认为需要了解的有关您的疾病/残疾的任何其他信息必填项！必填项！提交
