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ModulisticaEva Pisani2024-11-04T09:09:59+00:00

Forms

Personal data confidentiality

  • Privacy notice and data protection form

Imaging

  • Informed consent form for 2D/3D mammography
  • Informed consent form for conventional radiology
  • Consent form for iodinated or paramagnetic contrast medium administration
  • Medical history questionnaire and informed consent form for MRI and arthrogram MRI
  • Informed consent form for Computerized Tomography (CT scan and arthrogram CT)

Medical records

  • Medical records / certificate of inpatient admission

Rehabilitation

  • High-intensity laser therapy
  • Focused shock wave therapy

Registered office: Via IV Novembre 10/C, 35020 – Pozzonovo PD | Cap. Soc. 200.000,00 € | N° iscr. Reg. Imprese PD, C. F. e P. IVA 04606790287 | N° REA: PD – 403714

Phone: +39 0429 772906  |  Email: info@mediclinic.it
Fax +39 0429 772965  |  PEC mediclinicsrl@pec.it |

Health director Dott. Giacomo Garetto

Authorization N° 242 / 05.06.2025

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