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Solicitud de DEMO de MediQ Historia Médica
Información requerida para otorga DEMO del Sistema MediQ Historias Médicas en la Nube
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Titulo
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Dr o Dra
Lcdo o Lcda
Other:
Nombre Completo
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Your answer
Especialidad Principal
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Your answer
Numero de Cedula
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Your answer
Numero de Colegio
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Your answer
Numero de Ministerio de Salud
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Your answer
Dirección de Consultorio
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Your answer
Teléfono de Contacto
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Your answer
Movil - Solo Numeros. Ej 04249996633
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Your answer
¿Desea Incorporar su Firma digital a los Documentos de Consulta?
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SI
No
Correo electrónico
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Your answer
¿Como nos permite contactalo?
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Whatsapp
Correo Electrónico
Llamada Teléfonica
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Nota Adicional
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