더원서울안과는 서울 강남구 신사역 인근 신사스퀘어에 위치한 안과로, 망막질환·녹내장·백내장·노안·시력교정(라식·라섹·안내렌즈삽입술)·소아근시·안구건조증 등 안과 전문의 진료를 제공합니다. 신분당선 신사역 6번 출구에서 약 307m 거리에 있습니다.
의료법 시행규칙 [별지 제9호의2서식] <개정 2018. 9. 27>
Examples: Copy of medical records, copy of prescriptions, copy of surgery records, copy of test results and findings, radiological images (including digital media), copy of nursing records, copy of midwifery records, copy of medical certificates, copy of death certificates or autopsy reports, etc.
I (or legal representative) consent to the representative ( ) accessing or obtaining copies of my medical records in accordance with Article 21, Paragraph 3 of the Medical Service Act and Article 13-3 of the Enforcement Rules of the same Act.
Attach resident registration
Handwritten signature field