prescription form

Leopoldo Arús Gálvez

MINSAP

1972

20th Century

Modelo 53-05

Inscription

surface

MOD. 52-05 MINSAP-DS-U. P. I. 200,000 K. MINISTERIO DE SALUD PUBLICA HOSPITALES Y POLICLINICOS UNIDAD: NOTA: SOLAMENTE SE PODRA FORMULAR UN MEDICAMENTO EN CADA RECETA FECHA MEDICO PACIENTE-NOMBRE HISTORIA CLINICA No. INGRESADO PENSIONISTA C. EXTERNA SALA CAMA 274 09-D2/23838

Spanish

MOD. 52-05 MINSAP-DS-U. P. I. 200,000 K. MINISTRY OF PUBLIC HEALTH HOSPITALS AND POLYCLINICS UNIT: NOTE: ONLY ONE DRUG MAY BE FORMULATED ON EACH PRESCRIPTION. DATE PHYSICIAN PATIENT-NAME MEDICAL HISTORY No. ADMITTED PENSIONER EXTERNAL ROOM BED 274 09-D2/23838

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Hago constar que Enrique Hernandez Herrera, de 64 años de edad, vecino de la calle Jovellar #5, entre Marina y Soledad, Apto. 11, tercer piso, en La Habana presenta hipertensión arterial marcada así como trastornos nerviosos, todo lo cual le impide salir a la calle, ir al cine, etc. motivo por el que necesita que le reparen el televisor roto. 29 de Febrero de 1972

Spanish

I hereby state that Enrique Hernandez Herrera, of 64 years of age, resident of Jovellar Street #5, between Marina and Soledad, Apt. 11, third floor, in Havana, presents marked arterial hypertension as well as nervous disorders, all of which prevents him from going out in the street, to the movies, etc., which is why he needs to have his broken television set repaired. February 29, 1972

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