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REPORTE DE ESTUDIOS COMPLEMENTARIOS
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Nombre y Apellido del Afiliado
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Numero de Afiliado
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¿Que estudio le realizaron?
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¿Donde se realizo el estudio?
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Fecha y Hora Aproximado:
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DD
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YYYY
-¿Usted tiene el Informe?
Si, el informe y el estudio lo tengo yo
No,el informe lo tiene el medico
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- Relate por favor la atencion en el servicio que asistio
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