ORDER OF FEDERAL SERVICE ON SURVEILLANCE IN HEALTHCARE AND SOCIAL DEVELOPMENT

of November 6, 2007 No. 3542-Pr/07

About approval of the document forms used by Federal Service on Surveillance in Healthcare and Social Development in the course of licensing of activities for production of prosthetic and orthopedic products by orders of citizens

In pursuance of item 3 of the order of the Government of the Russian Federation of 11.04.2006 N 208 "About approval of the document form, confirming license availability" (The Russian Federation Code, 2006, N 16, the Art. 1746) and according to the order of the Government of the Russian Federation of 26.01.2006 N 45 "About the organization of licensing of separate types of activity" (The Russian Federation Code, 2006, N 6, the Art. 700), and the Regulations on Federal Service on Surveillance in Healthcare and Social Development approved by the order of the Government of the Russian Federation of 30.06.2004 N 323 (The Russian Federation Code, 2004, N 28, Art. 2900; N 33, of the Art. 3499) and the order of the Government of the Russian Federation of 04.11.2006 N 647 "About approval of the Regulations on licensing of activities for production of prosthetic and orthopedic products by orders of citizens" (The Russian Federation Code, 2006, N 46, to the Art. 4797), I order:

1. Approve document forms, prosthetic and orthopedic products used by Federal Service on Surveillance in Healthcare and Social Development in the course of licensing of activities for production by orders of citizens:

1.1. Statement for provision of the license (Appendix N 1).

1.2. The statement for renewal of the document confirming license availability (Appendix N 2).

1.3. Notification on provision of the license (Appendix N 3).

1.4. The notification on refusal in provision of the license (Appendix N 4).

1.5. The notification on renewal of the document confirming license availability (Appendix N 5).

1.6. The notification on refusal in renewal of the document confirming license availability (Appendix N 6).

1.7. The statement for issue of the statement from the register of licenses (Appendix N 7).

1.8. The statement for issue of the duplicate of the document confirming license availability (the copy of the document confirming license availability) (Appendix N 8).

1.9. The statement for prolongation according to the procedure of renewal of the document confirming license availability (Appendix N 9).

1.10. The notification on prolongation according to the procedure of renewal of the document confirming license availability (Appendix N 10).

1.11. The notification on refusal in prolongation according to the procedure of renewal of the document confirming license availability (Appendix N 11)

2. To assign the organization of work on licensing of activities for production of prosthetic and orthopedic products for orders of citizens to Management of licensing in the field of health care and social development (A. A. Korsunsky).

3. To impose control of execution of this order on the deputy manager of Federal Service on Surveillance in Healthcare and Social Development I. F. Seryogina.

Appendix №1

to the order of Federal Service on Surveillance in Healthcare and Social Development of November 6, 2007 No. 3542-Pr/07

Statement for provision of the license

 
 Регистрационный номер:___________________________________от___________
                      (заполняется лицензирующим органом)
         
                                В ФЕДЕРАЛЬНУЮ СЛУЖБУ ПО
     Штамп учреждения           НАДЗОРУ В СФЕРЕ
                                ЗДРАВООХРАНЕНИЯ И
                                СОЦИАЛЬНОГО РАЗВИТИЯ
         
                              ЗАЯВЛЕНИЕ
     (для юридического лица или индивидуального предпринимателя)
         
    +-ї
    | |О  предоставлении  лицензии  на  осуществление  деятельности по
    +-+изготовлению протезно-ортопедических изделий по заказам граждан

    +-їОб оформлении    приложения   к   лицензии   на   осуществление
    | |деятельности по изготовлению протезно-ортопедических изделий по
    +-+заказам граждан

N ____________, предоставленной_______________________________________
                                (наименование лицензирующего органа)
на срок действия с_____________по______________
         
+---+------------------------------------+---------------------------+
|1. |Организационно-правовая      форма и|                           |
|   |полное   наименование   юридического|                           |
|   |лица/                               |                           |
|   |Фамилия, имя,  отчество  (в  случае,|                           |
|   |если  имеется),  данные   документа,|                           |
|   |удостоверяющего             личность|                           |
|   |индивидуального предпринимателя     |                           |
+---+------------------------------------+---------------------------+
|2. |Сокращенное наименование *          |                           |
|   |(если имеется)                      |                           |
+---+------------------------------------+---------------------------+
|3. |Фирменное наименование *            |                           |
+---+------------------------------------+---------------------------+
|4. |Место нахождения юридического лица; |                           |
|   |Место   жительства   индивидуального|                           |
|   |предпринимателя                     |                           |
|   |(с указанием почтового индекса)     |                           |
+---+------------------------------------+---------------------------+
|5. |Почтовый адрес лицензиата/соискателя|                           |
|   |лицензии                            |                           |
|   |(с указанием почтового индекса)     |                           |
+---+------------------------------------+---------------------------+
|6. 

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