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  • Formulario Unico Afiliacion Famisanar

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    10 views3 pages

    Formulario Unico Afiliacion Famisanar

    Uploaded by

    Jhonatan FP

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 3
    FORMULARIO UNICO DE AFILIACION Y REGISTRO DE NOVEDADES AL SGSSS 4 Famisanar eeeeecin NT 830.003.5607 ana paros pet TRAMITE Lantos nsruciones qu encuentran anenasaformuiio ants de atigencans [21.0| a] m4] A] AL ALA ‘Poems Tipo nase tine fe Tpoor oo Sao com weaseas CESM Secs, Ete, Gises Bic ‘Role a ~— Souase . [eomcet hema —= ZARACINW ONTOS wSiCO8 DEETICACON las eabs 6 ] iia Sept Ate Pine ee Sepronerion arate ‘inraa Forwnia] umctrol | peomoms’ | © | O MI MPAA LALA [hes emeeaar 7 TESS SpE EN] Naa aSoS oa TOT ARS TER 1 freee eid nace TF] ei crest ata eee tet cme eo ‘BATS be WERTIREAGIN DE 08 MENBRGE DEL NUELEOFANLIAR ioe e enn crys oa ee TAOS rr son Semin Anat Pome ms souron mentee Ean = FiomoLTumcael]| woes’ | © 10 | M {MIA LA [ALA SES [a neat ame cen Fag] aR = = ‘egos, DATOS De ENTICACION DEL ENPLEADOR OTROS APORTAWTES ODE LAS EN TOROES RESPONSABLES DE LXAFICACIO COLEC TI ‘ODEOAE- eRe mel Tyee seer [—] 7 rr aor en] H Tipe et ost ROR] seo = ee ee Soe ee eee {rsa tana So pnatlcoart[ ) 1 Reporter sePreprarae|_] 1 pte ewes Pre mo Eee tc te bie 5.5 pn spre rin apn ton ci nine Oo 5 So ot og ut on rsenne oar cuore tin en conan brace unin atl 53 apenas mr lh naon te apr x ei, conan arena am Gi £2: Go aldactone prc np pti ol ceriedo de etn dee partes ol eran ct por ez era sven cd 8 Seca eee oe 5 5 cipman ane uel c esr nnn cpanel deere rane stat (SS EE ee ara , Ce) | Cd | Jo iar aralovoimimparaiaia i = Les nn) — = oss pecan Pm a od ‘5 EFamisanar CUESTIONARIO ENTREGA CARTA DE DERECHOS Y DEBERES. DEL AFILIADO Y DEL PACIENTE EN EL SISTEMA GENERAL DE SEGURIDAD SOCIAL EN SALUD ‘Y DE LA CARTA DE DESEMPENO sl No EPrevio al dligenciemierta del formulano de aitacion. a [| [~] EPS lo hizo enirege de Ia Carta de Derechos y Deberes ‘dol Aftiado y det Pacionte? ePrevio al dligenciemierto del formulario de aiiaci6n, la [| [] EPS le hizo entrega dela Caria de Desompefio donde se prosonta do manora cara su puesto en el ranking?

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