GUIAS DE ATENDIMENTO POR MÉDICO - AMBULATORIAL

Declaramos para os devidos fins, que o Sr.(a) ____________________________

Compareceu no Centro de Diagnósticos Avançados Renaud Scan - Bangu

Dia: ___/___ /___ às __:__

Para realizar a retirada das guia referente aos dias:

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Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____

Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____

Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____

Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____

Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____ Dia: ___/___ /____

Responsável:_________________________________________

Contato:

2424-6111 9 9791-6075