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Inventory and reporting documentation, form КЛ-001/о
According to the Regulation on the provision of medical services "NODUS" LTD Approved by the order of the director of "NODUS" LTD number 1 - agp dated 01.03.11
Option number 1

To Oleksandr Kulyk, MD, Director of "Nodus" LTD

FIRST APPEAL AND APPROVAL FOR MEDICAL intervention / MEDICAL SERVICE

I appeal to you and ask to consider the possibility of developing and implementing an individual program of restorative treatment and rehabilitation, as well as conducting medical advisory services on rehabilitation, general strengthening and health improvement in neurology and neurosurgery

Special notes:



Health status: (select)

I am fully acquainted with the system of organization of medical care for patients in the "NODUS" LTD

I do not deny that other competent medical institutions are involved in my examination and treatment. By signing this document, I fully agree with all the clauses of this document and give voluntary consent for medical service and medical intervention (consultations, application of diagnostic methods, as well as the use of a set of medical interventions that will complement and provide an adequate diagnostic process).

Nevertheless, below, I indicate the medical interference I refuse under any circumstances, except in cases of prevention and elimination of an immediate threat to my life:

I know that there is no absolutely safe medical intervention and any medical effects on a person cause the corresponding reactions of his body, which can sometimes be atypical and unpredictable. I understand that the medical and non-medical specialists of the SPCNR "NODUS" will make every effort to prevent threats to my life or damage to his / her health during consultations and instrumental and laboratory examination.
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We would like to remind you that your desire to undergo additional examination and rehabilitation program is your expression of Goodwill. Therefore, we look forward to the integrity and seriousness of our further cooperation. The information received during this examination will be kept confidential and protected in accordance with the current legislation. Payment of examinations and consultations is carried out by the legal representative of the patient or by the patient independently on the current account of the Center or is paid in cash to the cash desk (payment is possible through the cash terminal).
Inventory and reporting documentation, form КЛ-001/о
According to the Regulation on the provision of medical services "NODUS" LTD Approved by the order of the director of “NODUS” LTD number 1 - agp dated 01.03.11
Option number 2

To Oleksandr Kulyk, MD, Director of "Nodus" LTD

FIRST APPEAL AND APPROVAL FOR MEDICAL intervention / MEDICAL SERVICE

I appeal to you and ask to consider the possibility of developing and implementing an individual program of restorative treatment and rehabilitation, as well as conducting medical advisory services on rehabilitation, general strengthening and health improvement in neurology and neurosurgery

Documents (Birth certificate, Marriage certificate, documents confirming family ties)
Special notes:



Health status: (select)
For this purpose I provide such copies of documents:

I am fully acquainted with the system of organization of medical care for patients in the "NODUS" LTD

I do not deny that other competent medical institutions are involved in my examination and treatment. By signing this document, I fully agree with all the clauses of this document and give voluntary consent for medical service and medical intervention (consultations, application of diagnostic methods, as well as the use of a set of medical interventions that will complement and provide an adequate diagnostic process).

Documents (Birth certificate, Marriage certificate, documents confirming family ties)
Nevertheless, below, I indicate the medical interference I refuse under any circumstances, except in cases of prevention and elimination of an immediate threat to my life:
I know that there is no absolutely safe medical intervention and any medical effects on a person cause the corresponding reactions of his body, which can sometimes be atypical and unpredictable. I understand that the medical and non-medical specialists of the SPCNR “NODUS” will make every effort to prevent threats to my life or damage to his / her health during consultations and instrumental and laboratory examination.
or causing harm to his (her) health during consultations and instumental and laboratory examinations"
Type the letters you see on the picture*
CAPTCHA

We would like to remind you that your desire to undergo additional examination and rehabilitation program is your expression of Goodwill. Therefore, we look forward to the integrity and seriousness of our further cooperation. The information received during this examination will be kept confidential and protected in accordance with the current legislation. Payment of examinations and consultations is carried out by the legal representative of the patient or by the patient independently on the current account of the Center or is paid in cash to the cash desk (payment is possible through the cash terminal).
Донині в Нодусі діє Благодійний проект реабілітаційного лікування поранених в зоні АТО військовослужбовців та добровольців
Post-COVID
neuropsychological rehabilitation
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