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Get FL DH 1896 2004

paciente en caso de que éste sufra un paro cardíaco o respiratorio. (___)___-____ (Firma del médico) (Fecha) Número telefónico (Emergencia) (Escriba el nombre con letra de imprenta o digítelo) FORMULARIO (Número de licencia médica) 1896 DEL DEP. DE SALUD, revisado en diciebre de 2004 DECLARACIÓN DEL MÉDICO Yo, quien suscribe, un médico licenciado de acuerdo con el Capítulo 458 ó 459 de los Estatutos de Florida, soy el médico del paciente anteriormente mencionado. Por medio .

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