ࡱ> _rbjbj4bbGh h 8a"jl++++sssh!j!j!j!j!j!j!$#}&r!sssss!++H"___sj++h!_sh!__B+C/mZT!1"0a"b,&_&"&ss_sssss!!_sssa"ssss&sssssssssh ! :Certificado Mdico para Martimos Medical Certificate for Seafarers Exames mdicos realizados de acordo com as orientaes fixadas pela OIT/OMS para as inspeces mdicas de acesso inscrio martima e peridicas a fazer aos martimos. Certificado de Aptido Mdica emitido em conformidade com as disposies legais aplicveis e os requisitos internacionais estabelecidos pela Conveno Internacional sobre Normas de Formao, Certificao e de Servio de Quartos para os Martimos (STCW, 1978) conforme Emendas, a Conveno do Trabalho Martimo (MLC, 2006) da OIT e o Decreto-Lei 34/2015 de 4 de maro. / Medical Examinations conducted in accordance with ILO/WHO Guidelines for pre-sea and periodic Medical Fitness Examinations for seafarers. Medical certificate issued under the provisions of the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers (STCW, 1978) as amended, by the Maritime Labour Convention (MLC, 2006) of ILO and under Portuguese Law Decreto-Lei 34/2015, March 4th. Autoridades Competentes Direo-Geral de Recursos Naturais, Segurana e Servios Martimos / Direo-Geral da Sade Competent Authorities Directorate-General of Natural Resources, Safety and Maritime Services / Directorate-General of Health Identificao do martimo / Seafarer information Apelido (Last name)  FORMTEXT      Nome (First name)  FORMTEXT      Nomes do meio (Middle names)  FORMTEXT      Data nascimento (DD/MM/AAAA) / Date of Birth (DD/MM/YYYY)  FORMTEXT    / FORMTEXT    / FORMTEXT       Nacionalidade / Nationality  FORMTEXT      Gnero / Gender Masculino/Male Feminino/FemaleCdula martima / Passaporte / Carto Cidado n Seafarer s Book / Passport / Citizen cardVlido at / Valid until  FORMTEXT    / FORMTEXT    / FORMTEXT      Emitido por / Issued by  FORMTEXT       Os documentos de identificao do martimo foram verificados no local do exame? Sim / Yes Identification documents of the seafarer were checked at the point of examination? No / No Declarao do mdico reconhecido / Declaration of the recognized medical practitioner Viso (norma do Cdigo STCW seco A-I/9) / Sight (standards in STCW Code section A-I/9)Acuidade visual satisfatria / Satisfactory visual acuity Sim / Yes No / NoViso das Cores satisfatria / Satisfactory colour vision Sim / Yes No / NoData do ltimo teste de viso das cores / Date of last colour vision test  FORMTEXT    / FORMTEXT    / FORMTEXT       Avaliao obrigatria de 6 em 6 anos / Testing only required every six years) Auxiliares de viso necessrios? / Visual aid required? Sim / Yes No / NoAudio (norma do Cdigo STCW seco A-I/9) / Hearing (standards in STCW Code section A-I/9)Acuidade auditiva satisfatria / Satisfatory hearing acuity Sim / Yes No / NoAcuidade auditiva sem prtese satisfatria / Satisfatory unaided hearing Sim / Yes No / No Avaliao da aptido / Fitness assessmentCom base nas declaraes do martimo, exames clnicos e testes de diagnstico por mim executados, declaro que o martimo se encontra: / On the basis of the seafarer s personal declaration, my clinical examination and the diagnostic test results, I declare the seafarer:Servio de vigia na ponte / Look-out dutiesServio de mar / Sea services Funo/Position: Convs/Deck   !"#6DEFS_    & + Y ˿tttii^h$:hmCJ aJ h$:hrwoCJ aJ h$:h @ A K L   (.24HJLVXͶrbRrDjvhV6h}UUhV6h16CJaJmH sH hV6h16CJaJmH sH hV6h1CJaJmH sH hV6h1CJaJmH sH  jhV6h}UUmHnHujhV6h}UU hV6h}UjhV6h}UUhV6h16CJaJhV6h1CJaJhckhu5CJaJh,Uh@ƷyngYnHn9hV6h}UCJaJmH sH  jhV6h}UUmHnHuj{hV6h}UU hV6h}UjhV6h}UUhV6hw6CJaJmH sH hV6h5S&6CJaJmH sH hV6h}MCJaJmH sH hV6h5S&CJaJmH sH hV6h.CJaJmH sH hV6hwCJaJmH sH  jhV6h%AUmHnHujhV6h%AUjhV6h%AU@LNPR^fltvxz|ôÔtteVGhV6heCJaJmHsHhV6h.CJaJmHsHhV6hUCJaJmHsHhV6hNP²sdUFd;/hV6hib6CJaJhV6hibCJaJhV6h'CJaJmH sH hV6h}UCJaJmH sH hV6hoCJaJmH sH hV6hibCJaJmH sH hV6h[R6CJaJmH sH hV6h6CJaJmH sH hV6hck6CJaJmH sH hV6hib6CJaJmH sH hV6hbZ6CJaJmH sH hV6hbZCJaJmH sH hV6hib6CJaJmH sH hV6hibCJaJmH sH  "fh"$&(26Ϳuj_SLAhV6h7CJaJ hV6hibhV6hib6CJaJhV6hrwoCJaJhV6hCJaJhV6h5S&CJaJhV6hibCJaJhV6hib56CJaJhckhw5CJaJhckhck5CJaJh&h5S&56CJaJh&hbZ56CJaJh5CJaJhckh_5CJaJhh lS5CJ aJ hV6hbZhV6hbZCJaJ "~eJ$d$Ifa$gdV6l  & F d(^`gd$: d(^gd lSnkd;$$Iflr5&& t0&644 lap ytV6.uZ$d$Ifa$gdV6l $d$Ifa$gdV6l nkd$$Ifl=&& t0&644 lap ytV6(,.0hnp0ǼӇ{ӓpdYNjhV6h%AUhV6h.CJaJhV6hJ16CJaJhV6hJ1CJaJhV6h}6CJaJhV6h} 6CJaJhV6h} CJaJhV6h5S&CJaJ hV6hibhV6hib6CJaJhV6hibCJaJhV6h76CJaJhV6h}6CJaJhV6h}CJaJhV6hckCJaJhV6h4"CJaJ.0xU:$d$Ifa$gdV6l "$<d$If^`bBbdbtb~bbbbbbbbbbc cJcLc^cfccccccdddBdddø٪ymymymymymymahV6h$J6CJaJhV6hU6CJaJhV6hUCJaJhV6hU6CJaJmH sH hV6hUCJaJmH sH  hV6hUhV6h%A56CJaJhV6h%ACJaJhV6h^7CJaJhV6hCJaJhV6h^76CJaJUhV6h6CJaJhV6h%A6CJaJ& Cmaras/Catering Casa das Mquinas/Engine Outra/Other _________________ Apto / Fit Inapto / Unfit No aplicvel / Not applicable Apto / Fit Com limitaes ou restries / Limitations or restrictions Sim / Yes No / No Se sim, especifique / If so, specify ___________________________________________________________________ Inapto / UnfitO martimo sofre de doena suscetvel de ser agravada pelo, ou torn-lo inapto para o servio de mar ou de colocar em risco a sade de outras pessoas a bordo? / Does the seafarer suffer from any disease likely to be aggravated by, or to render him unfit for service at sea or likely to endanger the health of other persons on board? Sim / Yes No / NoData de emisso do certificado (DD/MM/AAAA) / Certificate issue date (DD/MM/YYYY)  FORMTEXT    / FORMTEXT    / FORMTEXT       Data de validade do certificado (DD/MM/AAAA) Certificate expiry date (DD/MM/YYYY)  FORMTEXT    / FORMTEXT    / FORMTEXT      Nome do Mdico / Medical Practitioners name Assinatura do Mdico / Medical Practitioners Signature ___________________________________________________________ Cdula Profissional n / Physician s Licence No. ____________________ Vinheta do Mdico / Medical Practitioners Stamp  Entidade onde foi emitido o Certificado de Aptido Mdica / Issuing AuthorityCarimbo da Entidade (se aplicvel) / Issuing Authoritys Stamp (if applicable) Morada / AddressContacto telefnico / Contact Confirmo que fui informado do contedo deste certificado e do direito a recorrer, de acordo com o pargrafo 6 da Seco A-I/9 do Cdigo STCW I confirm that I have been informed of the contents of this certificate and the right to ask for a review in accordance with paragraph 6 of section A-I/9 of the STCW Code _________________________________________ Assinatura do martimo / Seafarers signature     Repblica PortuguesePortuguesa Republic M-DSAM-804(0) bbbcLchcddx`HH```d$IfgdV6l d($IfgdV6l kd$$Ifl0=& t0&644 lapytV6dddd eeeLfRfggggggggg4hn@n^n`nfnhnznnnǼ}qeYR hV6h *hV6hCJaJhV6h6CJaJhV6h 6CJaJhV6hCJaJhV6h6CJaJhV6hCJaJhhwCJaJhhdm"CJaJ hV6hthV6hCJaJhV6ht6CJaJhV6h.CJaJhV6hU^6CJaJhV6hU^CJaJhV6hL^CJaJm m"m$mmm`nbnvi\AAAA$d$Ifa$gdV6l $da$gd lS $da$gd.kd$$Ifl10=&6s t0&644 lapytV6bndnfnhnnnZkd$$Ifl405&?`b t0&644 lapytV6$d$Ifa$gdV6l nnnnnnnnnoo@qqqqqqqqqqrrrr r r4rȽxplplplpl\J#hV6hO5CJOJQJ^JaJhV6hO5CJOJQJ^Jh|Ljh|LUhh8r=CJaJ hV6h8r=hV6h8r=6CJaJhV6h8r=6CJaJ hV6h8r=6CJaJ mH sH hV6h8r=CJaJhV6h8r=CJaJ hV6h8r=CJaJhV6h6CJaJhV6hCJaJ hV6hhV6hCJaJmH sH nnnnuZZ$d$Ifa$gdV6l kd2$$Ifl4G05&? b t0&644 lapytV6nnno@quR77$d$Ifa$gdV6l "$<d$If^`CJOJQJaJh<CJOJQJaJhOfghHCJOJQJaJh|L hOho hV6hO#hV6hO5CJOJQJ^JaJhV6hO5CJOJQJ^JhhOmHnHu jhfhhV6UmHnHuhV6hOCJaJhrrrrrrr $da$gd lSgdH21h:p+. 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