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Cerere de audienta
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Numele si Prenumele dvs.
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Insigna + Numele si Prenumele medicului reclamat

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Numarul dvs. de telefon
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Un email de contact + Numele de pe Discord
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Data Incidentului
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Explicati pe scurt ce s-a intmplat
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Atasati un link cu dovada video
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Atasati dovada ca poza
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