A nurse has appeared in court accused of the murder of three people.
Victorino Chua, 48, spoke only to confirm his name, age and address for the three minute hearing at Manchester Magistrates' Court.
He was charged following a lengthy investigation by police at Stepping Hill Hospital in Stockport.
Chua also faces 22 counts of attempting to cause grievous bodily harm with intent, seven charges of attempting to administer poison and one count of causing poison to be administered with intent.
He was remanded into custody to appear at Manchester Crown Court next Tuesday.
Diminutive Chua, a Filipino, wearing a Gap camouflage coloured hoodie, was dwarfed by the prison officer flanking him in the dock.
He replied "Yes Mam" to the clerk who told him he faces a total of 34 charges, including the murders of Tracey Arden, 44, Arnold Lancaster, 71 and Derek Weaver, 83.
As the charges are so serious, the case, and any bail application, can only be dealt with at the Crown Court, the defendant was told.
Ben Southam, prosecuting, told the court: "Mr Chua faces 34 allegations. I would ask that the case be sent to the Crown Court for a bail and preliminary hearing next week, on Tuesday.
"Mr Chua is not able to apply for bail here given the nature of the allegations.
"Bail will, in any event, be opposed by the Crown."
Mike McKeown, defending Chua, asked the court that the defendant is produced in person, rather than appearing by video-link, at the hearing next week.
Kevin Phillips, chair of the bench, told Chua: "We will remand you into custody and send to Crown Court for a bail and preliminary hearing."
Chua replied: "Yes sir. Thank you sir," before being handcuffed and led from the dock back to the cells.
All the alleged offences span a six-month period between June 1, 2011 and January 3, 2012, when patients where Chua worked at Stepping Hill were poisoned.
The three murders of Ms Arden, Mr Lancaster and Mr Weaver took place within a 14-day period, on the 7th, 11th and July 21st, 2011.
Chua, a father-of-two, was first held in January 2012, and has been on bail since then, but was re-arrested and charged on Friday.
Ann Barnes, chief executive of Stockport NHS Foundation Trust, which runs Stepping Hill Hospital, said: "We are very much aware that at the centre of this complex and lengthy police investigation are the patients and their families affected by these events.
"Our thoughts have been with them throughout this time.
"We are grateful for the continued support from all the communities we serve. We have always benefited from outstanding public support and confidence in our services and are pleased that this has never wavered.
"Our hospital has a strong track record and good reputation and people clearly recognise this.
"We would like to recognise and thank the staff for showing great professionalism throughout the police investigation.
"We have always had an excellent safety record and are ranked as one of the best hospitals in the country by the Care Quality Commission.
"We have worked closely with the police throughout the investigation and will continue to provide any support required.
"The safety of our patients will always be our highest priority."