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GALATI

Judetul ____________________
GALATI
Localitatea ____________________
CABINET MEDICAL DR. PROFIR ANCA
Unitatea sanitara ________________________________
SRL

SION
Nume _______________________________________
MARGARETA
Prenume _____________________________________
68 ani 2048
Sex M/F, Varsta ______ ani, Nr. RC/FO _________
DOMICILIU
GALATI GALATI
Judetul __________ Localitatea___________________
GH. ASACHI 3
Strada _____________________________ Nr _______
DIAGNOSTIC
_____________________________________________
606 ALTE FORME DE URTICARIE
_____________________________________________
_____________________________________________
_____________________________________________
RP.
TRIDERM 1-0-1
UNGUENT 0,5mg+10mg+1mg 1(unu)
_____________________________________________
/g

Data Semnatura si parafa medicului


___________
27.04.2020 _________________________
6 7 9 7 0 1