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  • Crj11/. 1-J : Affl Yj 'L

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    fmc

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    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    532 views1 page

    Crj11/. 1-J : Affl Yj 'L

    Uploaded by

    api-25095981

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    EARLVTERMINAnON OF TREATMENT

    FMC
    AGAINST MEDICAL ADVICE
    r--
    ADDRESSOGRAPH
    Date: /L-l4l' rXi/ ,!J/d
    [ .vf 16, /4 6 / !r- ! nJ ]
    I, 1..L<.c(1 2 reqUMt to terminate my treatment Prio; to th(1S
    prescribed time.
    a
    I willfully assume such risks and agFs8 not to
    .hold .. FM its em 10
    P b

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