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1. Bene
Hospital.
DATOS GENERALES
Doctor.
Cédula:
DIAZ TRETO RAFAEL JAVIER
PRESCRIPCIÓN
12120711
Nombre del Paciente: ANDRADE RODRIGUEZ CONSTANTINO
KETOROLACO 10MG TABLETAS
TOMAR 1 TABLETA VIA ORAL CADA 8 HORAS POR 3 DIAS
FLANAX 550 MG TABLETAS
TOMAR 1 TABLETA VIA ORAL CADA 12 HORAS SOLO POR5 DIAS.
OMEPRAZOL 2OMG CAPSULAS
Receta
TOMAR 1 CADA 12 HORAS POR 7 DIAS.
REPOSO LABORAL POR 2 DIAS.
REV 03
Beneficencia Española de Tampico
Centro Españcl de Tarnpico, AC.
Av. Hidalgo No. 3909, Cal. Guadalupe.
Tarnpico, Tam. C.P. 89120. Tel. [phone]
Licenca Sanitaria No. 13698
C4/07/2024
Cédula de Especialidad:
Edad:
Fecha:
59 AÑOs
Fina del Médico

2. Name: CONSTANTINO ANDRADE RODRIGUEZ
Nombre
ShipOwners/Operators: MARAESCO LTD
Amadores/Manejadores
Place, date and time where facts took place
Lugar, fecha y hora donde acaecieron los hechos
Witness of the events
Testigos de los hechos
First aid paid and by whom
Primeras ayudas prestadas y por quién
AT PORT:
Medicines applied to the patient on board
Medicinas suministradas o aplicadas al paciente a bordo
Shipping Agent, Mr./Messrs.
at TAMPICO, MEXICO
**************************
Name of the Doctor
Nombre del Doctor
Medical assistance requested by undersigner Master through
Diagnostic of the Doctor
Dictamen médico
Medical assistance rendered by Medical Center
Recibe asistencia médica en el Centro Médico
Treatment ordered by the Doctor
Tratamiento ordenado por el Doctor
ROBERTO PANTOJA
Fit/Unfit for work
Apto/No Apto para trabajar
2do Oficial, Capitan
Doctor
Prescribed medicines by the Doctor
Medicinas recetadas por el Doctor
TAMPIC0, MEXICO
*******.****.*i......
date
REPORT: SICKNESS / AGCIDENT
PARTE: ENFERMEDAD /ACGIDENTE
TRANSCONTINAL SHIPPING S.A DE C.V.
JULY 04 2024
*********.**.seensss**.**.**.
Agent
Rank:
Cargo
CREMA DESIMFLAMATORIA DICLOFENACO Y 02
PASTILLAS PARA EL DOLOR MELOXICA 15 MG
Vessel:
Buque
Period
Periodo
ELECTRICISTA
re****ure*****
MN MURUETA
Master/Capitán
M/V MURUETA
MASTER
PANAMA

3. To be filled by NAVESCO, S.A.
When repatried due to Sickness/Accident:
Cuando repatriado debido Enfermedad/Accidente:
Name:
Nombre
Disembarking Port
Puerto de desembarque
Being replaced by:
Siendo relevado por:
Rank
Cargo
CONSTANTINO ANDRADE RODRIGUEZ
Medical Center
Centro Médico
Doctor
Diagnostic
Medical assistance rendered in
Asistencia médcia recibida en
Unfit for work
No apto para trabajar
Fit for work
Apto para trabajar
Notice to the insurance
Notificación al seguro
Repatriation expenses
Gastos de repatriación
******************..*.**s*********.**.**********..*...****.***.**********.*
Replacement expenses
Rdeel Joner
Pagos hechos a cause de la baja
On Owners account
Con cargo al Amador
On account
Con cargo a
Name
Nombre
Payments because unfit for work
Hospitel
...........
Gonenteis.
1Bene.
DrnTeto.
............
Vessel:
*o-s............
Buque:
by:
volla cenecha,
*********************.............
por:
Port of joining
Puerto de embarque
Rank: ELECTRICISTA
Cargo
date
fecha
NAVESCO S.A.
date
fecha
date
fecha
date
fecha
U.S. $
MURUETA
U.S. $
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