Name of Institution ARCA Durban Arca Durban Hospital Practice No 0481572 Dr Naidoo Practice number 1474847 Name of Patient Email Address I.D. No Medical Aid Name Medical Aid No Name of Member Referral doctor’s Practice No I.C.D. Code. Please tick which is applicable. For dual addiction tick both Alcohol F102/350.2Drug Related F192/250.3 Date of Commencement of Treatment Please attach Copy of ID Please attach Copy of Medical Aid Card What is 5+2 This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
