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Ordo YESILTEPE

This medical prescription document contains information identifying the prescribing doctor, patient, recognized long-term affection, and prescribed medications including sitagliptin and metformin to be taken for 3 months. The document is signed digitally by Dr. Nizar NAASEH on July 26, 2023.

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195 views1 page

Ordo YESILTEPE

This medical prescription document contains information identifying the prescribing doctor, patient, recognized long-term affection, and prescribed medications including sitagliptin and metformin to be taken for 3 months. The document is signed digitally by Dr. Nizar NAASEH on July 26, 2023.

Uploaded by

akgun
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Cerfa Ordonnance Bizone

Articles L. 322-3, 3° et 4°, L.324-1 et R. 161-45 du code de la sécurité sociale.

n° 14465 * 01 PAMFOU, le 26/07/2023


21/02/2022
Identification du prescripteur Identification de la structure
(raison sociale du cabinet, de l'établissement et n°AM, FINESS ou SIRET)
Dr. Nizar NAASEH

N° ADELI : 771022324 N°RPPS : 10101801347

Identification du patient
Mr. Lucas YESILTEPEné
cas YESILTEPE nélele18/01/1995
18/01/1995
N° d'immatriculation
1950177305248333
1950177305248 33
Prescriptions relative au traitement de l'affection de longue durée reconnue (liste ou hors liste)
(AFFECTION EXONERANTE)
- 1] SITAGLIPTINE (phosphate) 100 mg cp (XELEVIA 100 mg Cpr pell Plq/30)
Prendre, par voie orale, 1 comprimé le matin, pendant 3 mois

- 2] METFORMINE EMBONATE 700 mg cp (STAGID 700 mg Cpr séc Plq/100)


Prendre, par voie orale, 1 comprimé le matin, le midi et le soir, pendant 3 mois

Signé via Doctolib le 26/07/2023


21/02/2022
Nizar NAASEH

Quiconque se rend coupable de fraude ou de fausse déclaration est passible de pénalités financières, d'amendes et/ou d'emprisonnement (article 313-
1, 441-1 et 441-6 du Code pénal, articles L.114-13 et L.162-1-14 du Code de la sécurité sociale).

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