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Mapfre formato 1 sctr 555555555555651651651651321320 cargado por ersinho diaz título mejorado con ia De atención médica sctr ser llenado por la empresa (campos obligatorios) De riesgo para prestaciones de salud, que hemos contratado con mapfre perú eps
Importante este formulario no equivale ni sustituye a la denuncia de accidente de trabajo o enfermedad profesional Partes del cuerpo afectadas (marcar con un círculo) ¿las lesiones sufridas por el examinado pueden atribuirse al accidente de trabajo indicado en ésta solicitud
¿qué consecuencias tiene o puede tener?
1 solicitud atencion medica sctr mapfre.pdf oficina principal av 28 de julio 873, miraflores, lima, perú t (511) 213 7373, f (511) 243 3131 www.mapfreperu.com sol 129 17 35kb read more Este documento es un formulario para solicitar atención médica por un accidente laboral Contiene secciones para proporcionar datos del empleador, del trabajador accidentado, del accidente, y una declaración jurada del empleador.
Quien firma y suscribe certifica la autenticidad de los datos del presente formulario en general y, especialmente, en los siguientes tópicos:veracidad del diagnóstico/correspondencia entre el diagnóstico y prescripción.
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