ࡱ> `b_[objbjoΐΐo BBBBBVVVV<V666669;;;;;;$T_B"_BB66mt=== B6B69=9===6V=%0=Q=B==__! : PREFEITURA MUNICIPAL DE PONTA GROSSA SECRETARIA DE SADE COORDENADORIA DE VIGILNCIA SANITRIA R E Q U E R I M E N T O Nome do Estabelecimento(fantasia) Razo SocialC.N.P.J. Inscrio EstadualI.S.S. / Alvara localizao nEndereo Bairro / LocalidadeTelefone Profissional - Responsvel Tcnico Identidade rgo exp.C.P.F. rgo e N(. do Conselho de Classe Telefone residencial e celular /Endereo Bairro/LocalidadeE-mail  Procurador C.P.F.R.G. S E R V I O S S O L I C I T A D O S ( ) INGRESSO DE RESPONSABILIDADE TCNICA ( ) BAIXA DE RESPONSABILIDADE TCNICA D O C U M E N T O S A APRESENTAR PARA INGRESSO DE RTPARA BAIXA DE RTAFotocpias de cdula/carteira profissional com foto do conselho de classe, cdula de identidade e C.P.F. do RT solicitante. Informar tambm telefone residencial e comercial, n de celular, ano e faculdade de formao, e-mail particular e comercial;AFotocpias de cdula/carteira profissional com foto do conselho de classe, cdula de identidade e C.P.F. do RT solicitante.BFotocpia do certificado de regularidade ou declarao de RT do respectivo Conselho de Classe, conforme o caso. BFotocpia da resciso do contrato de trabalho ou alterao social comprovando que o requerente deixou a sociedade ou declarao de que no ser mais o responsvel tcnico;CFotocpia de contrato de trabalho/CTPS, cpia do contrato social que comprove propriedade ou sociedade do profissional ou documento com indicao da responsabilidade tcnica.CCaso o estabelecimento dispense medicamentos sob regime de controle especial e/ou antimicrobianos; verifique nos artigos 21, 22 e 23 da RE n 590 (10/09/2014) os procedimentos e documentos aplicveis a serem adicionados no processo de solicitao de baixa de RT.DVia original do presente requerimento preenchido de forma clara e legvel, sem rasuras e assinado pelo RT requerente.DVia original do presente requerimento preenchido de forma clara e legvel, sem rasuras e assinado pelo RT requerente.EComprovante de quitao de taxa de responsabilidade tcnica em Guia de Recolhimento de Dbitos solicitar junto Praa de Atendimento. EComprovante de quitao de taxa de responsabilidade tcnica em Guia de Recolhimento de Dbitos solicitar junto Praa de Atendimento.FConforme o caso, se o estabelecimento no exercer atividades com substncias e medicamentos sob controle, apresentar declarao que no exercer, assinada pelo RT e proprietrio. FLicena Sanitria - original - Onde consta seu nome como RT pelo estabelecimento. Data: ___/____ /20___. 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