FORMULAR DE SESIZARE*

NUME SI PRENUME________________________________________________________

SOLICITANT_______________________________________________________________

(PACIENT/APARTINATOR/PERSONAL MEDICO-SANITAR/CONDUCERE UNITATE

SANITARA/ASOCIATIE PACIENTI)

SECTIA UNDE ATI FOST INTERNAT__________________________________________

DATA INTERNARII___________________DATA EXTERNARII_____________________

SESIZAREA DUMNEAVOSTRA VIZEAZA______________________________________

(incalcari ale drepturilor pacientului/conditionarea serviciilor medicale/abuzuri savarsite

asupra personalului medico-sanitar/alte aspecte)

CATEGORII DE PERSONAL IMPLICATE_______________________________________

(medici/asistente medicale/infirmiere/personal administrativ/conducerea unitatii

medicale/pacienti, apartinatori sau reprezentanti legali ai acestora)

VA RUGAM SA DETALIATI SESIZAREA DUMNEAVOASTRA:____________________

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ATI MAI SESIZAT ACEASTA PROBLEMA SI CATRE ALTE INSTITUTII?

DA___________________ NU___________________

VA MULTUMIM PENTRU IMPLICAREA DUMNEAVOASTRA IN ACEST DEMERS

IMPORTANT!

*Sesizarea se depune la secretariatul Sanatoriului Balnear si de Recuperare Mangalia