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預約領取COVID19口服抗病毒藥(Paxlovid)表單
本院接受民眾代持醫療院所釋出之處方箋領取口服抗病毒藥Paxlovid
服務時間:
星期一至星期五(上午10:00-11:30,下午14:00-16:30;不含假日)
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攜帶文件及注意事項：
1. 持有的紙本處方箋，上面有確診者姓名與醫療院所戳章，且處方內容只有Paxlovid，無其他藥品或衛材。
2. 帶著確診者本人的健保卡。
3. 請由非居家隔離、非居家檢疫、非自主防疫期間之親友代領，請勿親領。
預約領取日期:
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MM
/
DD
/
YYYY
預約領取時段:
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上午10:00-11:30
下午 14:00-16:30
確診者姓名:
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Your answer
確診者出生日期(年/月/日):
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Your answer
確診者身份證字號:
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Your answer
確診者聯絡電話:
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Your answer
代領者姓名:
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Your answer
代領者聯絡電話:
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Your answer
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