“yiR0g ap sojtwapide indus, uy (gyeo98 “ehrupesB ‘eSo10) awanoojoo uL yrwtid 24 nu Eg - ‘ouvosied Jor] ejeog ensue ES - ‘tuancad areod 0 nurooea aio ad vpvoq azaqawsju09 Bs - ‘wqysod 2389 ayepuentosas apimmpsoeA aysoulad nu nowt jnjidoo YORK] “sumdspi 8-s tur 1$ oyepueiiopen ajunursoea puraud axeganuy aout und ys voweqisod ynae wy cS eaxepHEAoDON BI) LMUPDIeA IY (AAA) stfoateu-yue uose,, eX. (HOR) BIODqR ‘woIO‘goofRs aOKEAL (OaA) fire ouronuoYod widow {df l A (La) s1uei2}-o10y1p u9eA, oG®ok#goao «i Qo os (4L@) sissnysd-ourjay-oryip wooe A, a (©@) zzojfoxoqr-nue mooeA, a (AGH) § BHedoynue uID08 A, roeznyoy iarepueniosy “Bue 2189 Hog LoySaoe eaTNodwi eaxeUIOoWA “eTMPWIOY Ul SAEUPSIEN UPA SMSASIA Y TOU WISITE SFGOT, ‘sooap 16 wino1 duos 9 EW os}4 Nd ‘aaeIT aseorjooyut tog juns “919 “Booth ‘eyrauOLod “Pajsnauod wasn) ‘Insouyja, ‘euayIp “ezoInoegn ‘gq eIeNA enedoy] AWI2T HH pe AA amintidoa je argues ap jnoupoyy $ out yo me Inpuioyeurhede / myayuued apouny, Db AY 209/90 WO PEND YO AGMA AMHo9 ajoumy FAVNIDOVA VI ZadarWDA ‘areyoepaouya) erBojontoprdg nong — gis ‘ane asa LE — 4nre jo AP LF — gre 90 of meq An - Lp argek wha JOUR “sioe fo FE RI HF A soxpuriedy / oisuzg yor, Uundap ad sojojuy ure-| 18 ayeype20) ut yuoUMo0p sade WO wre go 1wj29q $ “HOUIA Uy pupsio “nour [nuidoo nunquod wasvurooea idsooe ws 18 vaxamd quityos su-ys jod > ng Mnayoowa jmdaxp uy .gezryoy yeorew we 1S nour Inudoo najiod wrepuewooas vaseutoaea znyar es TEIEIOY ure “vayso0v e101 n> ASINOO Ht MOA o1Pod [a 2209 no STBORIET TOE T FS RANT AT TATOS SMES ESveIEUES ToOLIEd ay SUNT syeod HuguIoeA ynzwyor Bo nNg “SHPIEUIEUS Uy BHIOZIg0 EMZEd as 1 nu Bg -REFUZ LA VACCINARE Numele copilului FUlO® ALBERT Np copi 50012932 4 $80 Numele parintelui / apartingtorului FuCe pron > Medicul de familie al copiluui = DR Gr (HORE A Hepatita virali B, tuberculoza, difteria, tetanosul, tusea convulsiva, poliomiclita, rujeola, etc., sunt boli infectioase grave, cu rise mare de comip icatii gi deves. Toate acestea pot fi prevenite prin vaccinare, In Romania, vaccinarea impotriva acestor boli este gratuita: Recomandate: Refuzate: a Vaccin antihepatita B (HBV) Qo a Vaccin anti-tubercploza (BCG) a B Vaccin diftero-tetano-pertussis (DTP) i a Vaccin diftero-tetanie (DT) I 3 Vaccin potiomielitie exeikvP0) UPL oP ~A Trivavecin rujeold, oreion, rubeoki (ROR) o Vacein anti-rujeolic (VVR) a : a a Alte vaccinuri (la recomandarea MS) Am avut posibilitatea si pun orice intrebare privind vaccinarile recomandate si mi s-a rspuns. Daca copilul meu nu primeste vaccinurile recomandate este posibil: - Sé contracteze boala pe care vaccimul 0 poate preveni, ~ Si transmit boala altor persoane, ~ Si nu fie primit in colectivitate (cresi, gradinita, scoala) in ‘thal -enidlenndtlen die toatl~ Sa nui se permita calatoria fn straindtate. Cu toate acestea, am hotirat sd Tefuz vaccinarea Tecomandata pentru copilul meu si am marcat ,Refuzat” in dreptul vaccinuhii Stiu c& pot st-mi schimb parerea si sa accept vaccinarea pentru copitul meu, oricand in viitor. Declar cd am citit acest document in totalitate si Lam infeles pe deplin, Parinte / Apartinator bE Tata 23 of 20/S Martor HY #ORI AW SBpe Dat 20 06 ole Gf DSP JUD. SIBIU ~ Birou Epidemiologic Tehnoredactare: Dr.GM.