Documente Academic
Documente Profesional
Documente Cultură
Componenta prescriere
NBLDW 64628 x MF
NBLDW 64628 x MF
Serie ...................... Numar ...................................... Serie ...................... Numar ......................................
1. Unitate medicala AMBULATORIU 1. Unitate medicala AMBULATORIU
CMI DR VASILESCU MARIANA
........................................................................................ CMI DR VASILESCU MARIANA
........................................................................................
Adresa Adresa
SPITAL SPITAL
Bucureşti, SOS BERCENI, nr. 8, jud. BUCURESTI
........................................................................................... Bucureşti, SOS BERCENI, nr. 8, jud. BUCURESTI
...........................................................................................
20131485
CUI ................................. ROMANIA 20131485
CUI ................................. ROMANIA
CAS-B / A0802/2023 ALTELE ..... CAS-B / A0802/2023 ALTELE .....
CAS/Contract - conventie ...................................................... CAS/Contract - conventie ......................................................
Telefon / Fax medic prescriptor (cu prefixul de tara): +40744758434 Telefon / Fax medic prescriptor (cu prefixul de tara): +40744758434
Email medic prescriptor: cmidrvasilescumariana@yahoo.com Email medic prescriptor: cmidrvasilescumariana@yahoo.com
2. Asigurat 4811
FO/RC ..................... x Salariat Revolutionar 2. Asigurat 4811
FO/RC ..................... x Salariat Revolutionar
ZAHARIA Co-asigurat Handicap ZAHARIA Co-asigurat Handicap
Nume ............................................................................. Nume .............................................................................
CONSTANTIN-VALENTIN Liber profesionist PNS CONSTANTIN-VALENTIN Liber profesionist PNS
Prenume .......................................................................... Prenume ..........................................................................
Copil (<18 ani) Ajutor social Copil (<18 ani) Ajutor social
CID/CNP CID/CNP
Elev / Ucenic / Elev / Ucenic /
CE Somaj CE Somaj
4 0 7 8 2 5 5 2 5 4 8 7 8 9 8 5 5 6 1 4 Student (18 - 26 ani) 4 0 7 8 2 5 5 2 5 4 8 7 8 9 8 5 5 6 1 4 Student (18 - 26 ani)
PASS Personal contractual PASS Personal contractual
Gravida / Lehuza Gravida / Lehuza
21.04.1967
Data nasterii ............................. Card european (CE) 21.04.1967
Data nasterii ............................. Card european (CE)
Pensionar Pensionar
Acorduri Acorduri
Sexul x M F Cetatenia R O Veteran internationale
Sexul x M F Cetatenia R O Veteran internationale
Lista B 90% Alte categorii ........... Lista B 90% Alte categorii ...........
Pozitia
Cod Tip Tip Denumire comuna internationala / Denumire comerciala / Cantitate Numar zile % Pret Cod Tip Tip Denumire comuna internationala / Denumire comerciala / Cantitate Numar zile % Pret
D.S Lista D.S Lista
diag. diag. prescr. Forma Farmaceutica / Concentratie ( UT ) tratament ref. diag. diag. prescr. Forma Farmaceutica / Concentratie ( UT ) tratament ref.
1 453 C C METOPROLOLUM /COMPR. ELIB. PREL./50MG 1/zi 90 ( nouazeci) 90 90 A 1 453 C C METOPROLOLUM /COMPR. ELIB. PREL./50MG 1/zi 90 ( nouazeci) 90 90 A
2 486 C C CLOPIDOGRELUM /COMPR. FILM./75MG 1/zi 90 ( nouazeci) 90 50 B 2 486 C C CLOPIDOGRELUM /COMPR. FILM./75MG 1/zi 90 ( nouazeci) 90 50 B
3 453 C C PERINDOPRILUM /COMPR. FILM./5MG 1/2 45 ( patruzeci si 90 50 B 3 453 C C PERINDOPRILUM /COMPR. FILM./5MG 1/2 45 ( patruzeci si 90 50 B
cinci) cinci)
4 289 C C ATORVASTATINUM /COMPR. FILM./20MG 1/zi 90 ( nouazeci) 90 50 B 4 289 C C ATORVASTATINUM /COMPR. FILM./20MG 1/zi 90 ( nouazeci) 90 50 B
Poz.
Poz.
5.Justificare medicala prescriere denumire comerciala 5.Justificare medicala prescriere denumire comerciala