Application to keep the Pediatrician for over-14s

The undersigned:

for his/her son/daughter:
to keep the following Pediatrician
which is allowed only in case of:
  • Severe, chronic and persistent illness
  • Psycho-physical immaturity
  • Psycho-social conditions causing risks or severe physical problems
  • Brothers or sisters in charge of the same pediatrician
I have read the privacy policy on personal and health data treatment in AULSS 3 Internet site at the following link  and I agree to my personal data treatment for administrative purposes, according to the European Regulation (GDPR n. 2016/679) and Italian Privacy Code (D.Lgs. n. 196/2003, as amended and supplemented by D.L. n. 101/2018).