Beruflich Dokumente
Kultur Dokumente
ANEXO 16
ACEPTACIÓN DEL TRATAMIENTO ANTITUBERCULOSIS
Yo,…………………………………………...........................……………………LGHQWL¿FDGRDFRQ'1,1…………………………,
GRPLFLOLDGR D HQ …………………………………...............................................…….....................................………………………,
GHFODURYROXQWDULDPHQWHPLDFHSWDFLyQSDUDUHFLELUHOWUDWDPLHQWRSDUDWXEHUFXORVLV\KDEHUVLGRLQIRUPDGRDSRUHO0pGLFR
……………………......................................................……GHO(VWDEOHFLPLHQWRGH6DOXG……………………..........……GHOD',6$
',5(6$*(5(6$ …………….............……………VREUH ODV SRVLELOLGDGHV GH FXUDFLyQ R IUDFDVR D HVWH WUDWDPLHQWR \ GH OD
QHFHVLGDGGHFXPSOLUHVWULFWDPHQWHFRQODVLQGLFDFLRQHVPpGLFDV\GHOSHUVRQDOGHOHVWDEOHFLPLHQWR'HFODURWDPELpQKDEHU
VLGRLQIRUPDGRGHODVUHDFFLRQHVDGYHUVDVTXHSXGLHUDQSUHVHQWDUVHFRQORVPHGLFDPHQWRVTXHDFRQWLQXDFLyQVHVHxDODQ
0DUFDUFRQDVSDGRQGHFRUUHVSRQGD
&RUUHVSRQGLHQWHDOHVTXHPDGHWUDWDPLHQWR3$5$7%6(16,%/(
([FHSW~R GH UHVSRQVDELOLGDG PpGLFR OHJDO DO PpGLFR WUDWDQWH \ D OD (61 3&7 VL VH SUHVHQWDVH HYROXFLyQ GHVIDYRUDEOH R
FRPSOLFDFLRQHVGHULYDGDVGHOWUDWDPLHQWR
(QVHxDOGHFRQIRUPLGDG¿UPRHOSUHVHQWHFRQVHQWLPLHQWRLQIRUPDGR
……………………………………………………………………
),50$'(/3$&,(17(
'1,…………………………………………
),50$'(7(67,*2
120%5(<$3(//,'2………………...............................................……………………………………………………………………
'1,1………………………………......……............…… 7HOpIRQR……………………………….........…………………
'20,&,/,2……………………................................................……………………………………………………………………………
(QFDVRGHPHQRUHVGHHGDGHOSDGUHRWXWRUVHUiTXLHQ¿UPHHOFRQVHQWLPLHQWRLQIRUPDGR
)(&+$«««««««««««««
www.minsa.gob.pe