CHOOSING THE GENERAL PRACTITIONER BY DEROGATING RESIDENCE

The undersigned
According to the National Collective Agreement on General Medicine, applies to choose by derogating residence, for his/herself and for his/her relatives:
 
General Practitioner’s data:
Registered in the GP list of the following city:
Please note: If you have chosen a pediatrician belonging to a different Health Authority, you need to upload the consent of the Health Authority the new pediatrician is enrolled in, as well.
 
I have read the privacy policy on personal and health data treatment in AULSS 3 Internet site at the following link https://www.aulss3.veneto.it/privacy  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).