Date: 09 04 1997

Recipient: Mr. Serge Lacombe

Name of the payee: Lacombe, Serge

V/Dossier:                             N/D: 1411

In response to your received request: 03 04 1997

( )
Want find herewith the documents asked.
 
( )
The signature of two (2) witnesses is necessary in the cases of not-signature by the recipient. It must then affix a (x) and you must indicate the reason of the not-signature to it.
 
( )
The above mentioned person is hospitalized at present. The requested information will be provided to you with his leave.
 
( )
Person Ci-high mentioned was not treated with the dates specified in your request.
 
( )
We do not have any card concerning the above mentioned person and we turn over you Ci-Joint your request.
Required additional information:

( ) Name and first name with the birth:

( ) Date of birth:                           United:  

( )   Name and first name of the mother to the birth:

(X) Other:   We are not authorized to give you a copy of your file on 19 07 1995. Please to forward to us the name of your practitioner attending with his address, it will please to us to forward to him your medical file.

Hoping that this information will be useful for you, please receive my cordial greetings.

The head of the service
of the medical files
 
By:
/ lc

 

Affiliated at the University of Montreal
and the McGill University
 
Registered office: House Verdun
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Telephone:(514) 765-8121
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Telephone: (514) 365-1510
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