Transcription of APPLICATION FOR LICENSE TO OPERATE
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APPLICATION FOR LICENSE TO OPERATE
Form-HF-LTO-A Revision:03 08/02/2016 Page 1 of 5 APPLICATION FOR LICENSE TO OPERATE Name of Health Facility or Service Provider : Address : No. & Street Barangay City/Municipality Province Region Type of Health Facility or Service.
[ ] Total Body Irradiation (TBI) [ ] Percutaneous Transluminal Angioplasty [ ] Tumor Localization and Simulation . Form-HF-LTO-A Revision:03 08/02/2016 Page 5 of 5 Acknowledgement REPUBLIC OF THE PHILIPPINES ) CITY/ MUNICIPALITY OF ) S.S. I, , , of legal age, , a resident of Name C iv l S ta us Age ...
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