Anlage 4/2
zu
MEDIZINISCHE AUSSTATTUNG – KONTROLLDOKUMENT
für Seeschiffe der Kategorie B
I. Angaben zum Schiff
Name: .............................................................................................................................................
Flagge: ............................................................................................................................................
Heimathafen: ..................................................................................................................................
II. Medizinische Ausstattung
| Erforderliche Mengen | Tatsächlich an Bord befindliche Mengen | Bemerkun-gen (speziell: etwaiges Verfalls-datum) |
1. ARZNEIMITTEL |
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2. MEDIZINISCHES MATERIAL |
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3. ANTIDOTE |
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Ort, Datum: ...........................................................................................................................................
Unterschrift des Kapitäns: .....................................................................................................................
Sichtvermerk der Behörde, des Arztes oder des Apothekers: ...............................................................
