Date: 23.06.2014.
Name: Marko Marković DOB: 1st January 1970 Citizenship: Croatian Address: Ilica 1, 10000 Zagreb Country: Croatia Passport No.: 11111111
Diagnosis: - Crohn’s disease / Ulcerative Colitis -
Gastritis chr.
MEDICATION: -
mesalazine 3g/daily
-
methotrexate 15mg/weekly
-
infliximab 400mg every 2 months
-
Folic Acid 5mg/daily
_______________________ Name of doctor