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Doh HFSRB Qop01form1 Rev2 6172022
Doh HFSRB Qop01form1 Rev2 6172022
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
Note: Please refer to www.hfsrb.doh.gov.ph. for other details of the requirements. DOH-HFSRB-QOP-01 Form1
Rev:02
6/17/2022
Signature
known to me to be the same person/s who executed the foregoing instrument and they acknowledge to me that the
IN WITNESS WHEREOF, I have hereunto set my hands this ____day of ________________, 20___
DOH-HFSRB-QOP-01 Form1
Rev:02
6/17/2022
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