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 ...
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 ...
ropes and wires • Unprotected winding drums and machinery • Worn out components • Stopping systems inappropriate to emer- gency cases Precautions and measures: • Protection cages or barriers to avoid contact with mobile parts • Optical or acoustic signs of hazardous movements, emergency shutdown ...
: …….………………………………………………………. …………………………………………………………….. 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 ...
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 ...
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 ...
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 ...
NO NO 27) Do you have removable dentures or contact lenses? YES NO If you have anything else to report, please use the space below: ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… DATE ...
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 ...
