COfNACI4E

Ha rrpoBeAeHr{e [poor4naKrlrqecK[x rpr,rBnBoK nporrB covlD- I9

(OI4O naulrenra./gaxonnoro upe4crawnenx)

IOAA POXAEHI,I'
flpoxr,roalouuir (at) no Apecy:
(a4pec Mecra x([reJrrcrna./upe6unaHur)
Houep relerpona r[fl. cBfl3rt
Ha ocnoeaHllr crarbvI44 3arona Pecrry6ruaxn Benapycr or l8 ruonr 1993 r. Il!2435-XII <O :4panooxpaHeHr.rrr) Bbrpaxaro
cBoe corJlacl4e Ha [poBeAeuue npoQruIarr[tlecKl{x qpr,rBrrBoK nporrrB COVID-19 cBoeMy pe6enxy

(oZO, Aara poxAeHut, agpec)

Hacroqtq[M [oArBepxAalo, vro upor.IHipopMl,IpoBaH (a): o crraucle r{ rleJrr{ Baxrlr4Haur4r,r, o Bo3MoxHocrlr cAeJrarb rrpr,rBlrBKr4
[poTnB
COVID-I9
- t IIocraBLlJI (a) n nsnecruocrb MeAIruI{HcKofo pa6ournxa o paHee BbrrroJrHeHrrbrx MoeMy pe6enxy [pr,rBrrBKax;
- o nwru\uv/orcyrcrBrlr4 peaxqlrfi Ha rrpeAbrAyrrlr{e BBeAeHr.rrr BaKur4H;
- o Bcex Borlpocax, cBt3aHHbIx c ero (ee) 3AopoBbeM, B ToM r{r{cJre o Hzurra.ruulorcyrcrBtru aJrneprruecKrx npoauenraf,;
- o Bcex rlepeHecgHHblx paHee I4 I,BBecrHbIX rr.fire 6oresHrx, o npnHr,rMaenarrx pe6eHroM neKapcrBeHHbrx npenaparax;
- MHe f,cHo, qro rrocJre npoBeAeHr.rrr upoQularrnvecKrrx npriBrrBoK Bo3MoxHbr no6oqrure (nexenarenrnue) peaxqrur;
- MHe .qaHbr qerKr,re pa3brcHeHlrr o Morrx EencrBrrlx B cJryqae Bo3Hr4KHoBeHru uo6oqrsrx (nexenarenrrux) pearquft
nocJle npoBeAenu.r npoQunaKTlltlecKrrx [pr{Br4BoK,
a ruen(a) Bo3MoxHocrb 3aAaBarb rno6rre Bonpocbr no BaKrlr4Harrr{r,r [poruB COVID, MHe B Aocrynuoft 4aru
Qopue
t4c q epnbrB€lloIu],Ie oTBeTbI.
fiara lloAuracr

cofnAcutE
Ha npoBeAeHue npoQularrrrrrec Kr.rx [pr{Bl.rBoK rrporrdB C OVID- I 9

(OI4O uauzeura./saxonHoro npeAcraszrers)

roAa poxAeHI'Lu
flpoxruaroq utrr (at) no Apecy :
(a4pec Mecra xnreJnctna,/npe6rrnaaut)
Houep rene(poua cBfl3u
gri.fl,
Ha ocHosaHuw crairbvr 44 3axosa Pecrry6nuxn Benapycr or I 8 raorls 1993 r. Ilb2435-X[ <O s4panooxpaHeHr{r,r)) Bbrpaxaro
cBoe cofJlacl4e Ha [poBeAeuue npoQunaKrrrtlecKlrx [pr{BrrBoK nporlrB COVID-19 cBoeMy pe6eury

(OI4O, Aara poxAeHur, agpec)

Hacro.f,xluNa [oATBepxAaIo, vro upoutrQopMrrpoBaH (a): o currcne ]r rleJrr4 BaKurrHaur{r{, o Bo3Mo}KHocru cAeJrarb rrprrBr{BKu
Irporr4B
COVID-I9
- t [ocraBI,IJI (a) e uenecrnocrb MeAI,IuuHcKoro pa6ornuxa o paHee BbrrroJrHeHHbrx MoeMy pe6enxy [pr4Br,rBKax;
- o sanvnuuJorcyrcrBr,rlr peaxqraft Ha rrpeAbrAyrrllre BBeAeHr{r BaKrIr,rH;
- o Bcex Borlpocax, cBt3aHHbIX c ero (ee) 3AopoBbeM, B ToM qrrcJre o naflr.rnnlorcyrcrBr,rn ailrepil,rrrecKrx upornleuufi;
- o Bcex [epeHeceHHblx paHee IiI I,BBecrHbIX naue 6ore:n-sx, o [pr,rHrrMaeurrx pe6eHxoM JreKapcrBeHHbrx [pe[aparax;
- MHe [CHO' IITO IIocJIe IIpoBeAeHI4f, npot[nlaxrnvecKl4x npLIBI,IBoK Bo3MoxHbr no6o.Illbre (nexenarearnrre) pearqnul
- MHe AaHbl qerKI,Ie piBb.scHeHl4r o Motrx AeficrBr,rflx B cryrrae Bo3Hr4KHoBeHraq no6oqn6rx (ueNelarelrrurx) peaxUnff
rlocJIe ttpoBeAenrar npo$r,u aKTrrrrecKr,rx [pr{Br,rBoK,
a urr,rea(a) Bo3MoxHocrb 3aAaBarb ruo6rre Bo[pocbr [o BaKur.rHarr[u [porr4B COVID, MHe B Aocryrrnofi Qopue 4arur
llcqepllblBaro uIHe oTBeTbI.
[an lIoAruzcr