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.}{\fs28 \kerning2 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \f4 identificat prin
CI seria.................. nr ........................ domiciliat
in ........................
str ..................................................... nr .............. in
calitate de reprezentant legal al
minorului: ........................................................................
..........................CNP .....................................................
............}{\fs28 \kerning2 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \f4 \par }\
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hich \af4 \loch \f4 i-au fost furnizate}{\fs28 \kerning2 \rtlch \ltrch \dbch \af4 \
hich \af4 \loch \f4 \lang1048 \langnp1048 putine}{\fs28 \kerning2 \rtlch \ltrch \
dbch \af4 \hich \af4 \loch \f4 informatii privind vaccinurile}{\fs28 \kerning2 \
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putinele informatii furnizate de medic imi exprim refuzul pentru efectuarea
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ltrch \dbch \af4 \hich \af4 \loch \f4 \lang1048 \langnp1048 Conform prevederilor
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kerning2 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \f4 \lang1048 \langnp1048 Legea
nr. 46/2003 privind drepturile pacientilor
Art 13, si Legea nr. 95/2006 privind reforma sanatatii, Art. 374 si 376, am }{\
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Semnatura parinte ........................................}{\fs28 \kerning2 \
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