Change Of Physician Additional Treatment By Consent {WC-200a}

012015012015012012015012012015015015015015012015012 015015012015012015015015015012015012 !"!#$%$015%$"##!$015&''()***+,-*.+/012/3+/14 01201201501501501501201201501201201250150120150156%7+0150150128015++++9# + 015012%%$012015012015012012015012012 012015012015012012015012012 <,'2=.'31<,) >?@A?BAC@D@EFBG@HCA?IJ@BGBGKLAM?NOMPA?IQRSTA?QRSTUIVHBGMWKXKKEY?KW@AVHDZC@DKNJ@BGBGKLAM?N[QGKEY?AYK?DZK \K]VBKNMENC@DKNJ@BGBGKL AM?NOJ@BG]AY@KHY?AW@NKNBABGKEMIKNIKN@?NYV?HVMEBBA`[R[a[b[cd USeSfgg^X[ LAM?NRDM@ IhA[ iIYDAZKKjMHBhMIK iIYDAZKKP@?HBhMIK k[l[ mMBKAClEnV?Z +012012012015015012 015 RAVEBZAClEnV?ZkM@D@EFbNN?KHH iSIM@Db NN?KHHR@BZoBMBKp@Y +012012 T[qGK]V??K EBDZMVBGA?@rKNB?KMB@EFYGZH@]@ME@Hm?[skM@D@EFbNN?KHH hMIK R@BZ oBMBKp@YRANK f[qGKbVBGA ?@rMB@AE@H?KtVKHBKNCA?B?KMBIKEBXZm?[s kM@D@EF bNN?KHH hMIK R@BZoBMBKp@YRANK d[qGKMNN@B @AEMDB?KMBIKEBMVBGA?@rKN@Hs +012 u T[qGKYM?B@KHMF?KKBGMBM]GMEFK@EB?KMB@EFYGZH@]@MEBAm?[ @HM VBGA?@rKNO MENBGKKIYDAZK?@HBAXK?KHYAEH@XDKCA?YMZIKEBACEK]KHHM?ZMEN?KMHAEMXDKIKN@]MDK\YKEHKH@E]V??KNMHM?KHVDBACB?KMBI KEB?K ENK?KN XZBG@HYGZH@]@MEKCCK]B@WK vv[ u f[qGKYM O MENBGKKIYDAZK?@HBAXK?KHYAEH@XDKCA?YMZIKEBACEK]KHHM?ZMEN?KMHAEMXDKIKN@]MDK\YKEHKH@E]V??KNMHM?KHVDBACB?KMBI KEBOK CCK]B@WK vv [qGKY?@IM?ZB?KMB@EFYGZH@]@MEJ@DD?KIM@Em?[ [ qG@HMF?KKIKEB@HIMNKXZs o@FEMBV?K^iIYDAZK?A?wKY?KHKEBMB@WK iIYDAZ KKvbBBA?EKZhMIKx>?@EBiIYDAZK?vbBBA?EKZhMIKx>?@EB kM@D@EF b NN?KHH kM@D@EF bNN?KHH R@BZ oBMBKp@YRANKR@BZoBMBKp@YRANK iSIM@Db NN?KHHabLM?hV +015 ulGK?KX Z]K?B@CZBGMBlGMWKBANMZHKEBM]AYZACBG@HCA?IBAMDDYM?B@KHO]AVEHKDMENBGKMXAWKSEMIKNIKN@]MDY?AW@NK?HOMENBABGKoBM BKLAM?NACQA?yK? HzRAIYKEHMB@AEOf{g>KM]GB?KKoB?KKBOh[Q[ObBDMEBMOaKA?F@MdgdgdSTfee o@FEMBV? K iSIM@DmMBK>GAEKhVIXK?