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Information Manufacturer or Representative Representative Name/Position Contact Information Intended use of device in network-connected environment: MANAGEMENT OF PRIVATE DATA Yes, No, Refer to Section 2.3.2 of this standard for the proper interpretation of information requested in this form. N/A, or ...

ANNEX 2 TO THE CONSENT FORM COVID-19 VACCINATION ANAMNESTIC SHEET The vaccinee will fill in this form and review its content with the Health Professionals of the vaccination team. Name and Surname: Phone: Anamnesis YES NO I don’t know Are you currently sick? Do you have ...

, mental health in perpetual crisis. • Agreement on what “good” looks like. • To ensure “good” services, we may have  to look  globally ‐ GMH • Improving MH care in HIC may mean scaling  down services A new revolution in  mental health? A priority on improving  mental health and ...

to staff Pulls or removes tube(s) or catheter(s); aggressive Frequent non-purposeful movement, fights ventilator Anxious but movements not aggressive vigorous Not fully alert, but has sustained awakening (eye-opening/eye contact) to voice (≥10 seconds) Briefly awakens with eye contact to voice ...

managed entirely by Municipality of Trieste o educational project based on training component of game and historical structured activities (theater, sports, music and visual arts) o 13 recreation centers in different districts (3000 families) o children aged 6 to 18 years o payment of rates ...

: …….………………………………………………………. …………………………………………………………….. Health insurance card no. (if available) ……………………………………………………………………………….. I read, it was illustrated to me in a known language and I fully understood the Information Notice written by the Italian Medicines Agency (AIFA) about the vaccine ...

birth: I confirm that the parent/guardian/other person with parental responsibility was adequately informed and has given his/her consent to the vaccination. Permanent address: Health insurance card no. (if available) Phone: Signature ...

birth: I confirm that the parent/guardian/other person with parental responsibility was adequately informed and has given his/her consent to the vaccination. Permanent address: Health insurance card no. (if available) Phone: Signature ...

person with parental responsibility was adequately informed and has given his/her consent to the vaccination. Signature ........... ...... ..... ... ........ ...... ..... ...... ...... .... ........ ...... ..... ...... .... 2. Name and Surname (Doctor or other Healthcare Professional ...

0032264-11/07/2022-DGPRE-DGPRE-P - User attachment 2 (A02)   Versione 14. del 11/07/2022 / Revision 14. of 11 July 2022    ALLEGATO 1 AL MODULO DI CONSENSO VACCINAZIONE ANTI‐COVID‐19   ATTACHMENT 1  TO THE COVID‐19 VACCINATION CONSENT FORM    NOTA INFORMATIVA / INFORMATION NOTICE      COMIRNATY ...