{"id":13799,"date":"2013-07-26T12:09:58","date_gmt":"2013-07-26T10:09:58","guid":{"rendered":"https:\/\/www.aslroma5.info\/new2021\/modulistica\/"},"modified":"2026-04-03T14:11:48","modified_gmt":"2026-04-03T12:11:48","slug":"modulistica","status":"publish","type":"page","link":"https:\/\/www.aslroma5.it\/modulistica\/","title":{"rendered":"Modulistica"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"13799\" class=\"elementor elementor-13799\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-741cff00 noPaddingTop elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"741cff00\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4a5e5680 noPaddingTop\" data-id=\"4a5e5680\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f23174a elementor-widget elementor-widget-text-editor\" data-id=\"f23174a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00c8 possibile scaricare la modulistica utile per accedere ai servizi della ASL Roma 5.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1e3ff5e elementor-widget elementor-widget-text-editor\" data-id=\"1e3ff5e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Sezione relativa alle tipologie di procedimento, come indicato all&#8217;art. 35, c. 1,2 del d.lgs. 33\/2013<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bfdee24 elementor-widget elementor-widget-the7-accordion\" data-id=\"bfdee24\" data-element_type=\"widget\" data-widget_type=\"the7-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion the7-adv-accordion\" data-accordion-type=\"accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-2011\" class=\"elementor-tab-title the7-accordion-header deactive-default\" data-tab=\"1\" role=\"tab\" aria-controls=\"elementor-tab-content-2011\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Moduli generici<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-2011\" class=\"elementor-tab-content elementor-clearfix deactive-default\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2011\"><p>[.pdf] <a class=\"b\" href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/modulo-assistenza-sanitaria-cittadini-comunitari.pdf\" title=\"Assistenza Sanitaria Ai Cittadini Comunitari\" target=\"_blank\" rel=\"noopener\">Assistenza sanitaria ai cittadini comunitari<\/a> (2010)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/03\/modello_astensione_anticipata_dal_lavoro.pdf\" title=\"Astensione Anticipata Dal Lavoro Per Gravidanze A Rischio\" target=\"_blank\" rel=\"noopener\">Astensione anticipata dal lavoro per gravidanze a rischio<\/a> (2012)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2022\/04\/modulo-autocertificazione-esenzione-reddito-v4.pdf\" title=\"Autocertificazione Ai Fini Dell\u2019esenzione Dalla Partecipazione Alla Spesa Sanitaria Per Motivi Di Reddito E01 E02 E03 E04\" target=\"_blank\" rel=\"noopener\">Autocertificazione ai fini dell&#8217;esenzione dalla partecipazione alla spesa sanitaria per motivi di reddito E01 E02 E03 E04<\/a> (2022)<\/p><p>[.docx] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/01\/Modulo-domicilio-sanitario-2024.docx\" title=\"Iscrizione Temporanea Per Domicilio Sanitario\" target=\"_blank\" rel=\"noopener\">Iscrizione temporanea per domicilio sanitario<\/a> (2024)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/modulo-richiesta-frequenza-volontaria.pdf\" title=\"Richiesta Frequenza Volontaria\" target=\"_blank\" rel=\"noopener\">Richiesta frequenza volontaria <\/a>(2021)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/02\/modulo-mmg-pls.pdf\" title=\"Richiesta MMG \u2013 PLS\" target=\"_blank\" rel=\"noopener\">Richiesta MMG &#8211; PLS<\/a> (2024)<\/p><p>&#8212;<\/p><p><span style=\"text-decoration: underline;\">Esami Radiologici<\/span><\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/02\/consenso-informato-TC-2025.pdf\" title=\"Consenso Informato TC\" target=\"_blank\" rel=\"noopener\">Consenso informato TC<\/a>\u00a0(2025)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/03\/Consenso-informato-Risonanza-Magnetica-2025.pdf\" title=\"Consenso Informato Risonanza Magnetica\" target=\"_blank\" rel=\"noopener\">Consenso informato Risonanza Magnetica<\/a> (2025)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2022\/05\/ritiro-esami-radiologici-modulo-2022.pdf\" title=\"Richiesta Copia Di Esami Radiologici\" target=\"_blank\" rel=\"noopener\">Richiesta copia di esami radiologici<\/a> (2022)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-2012\" class=\"elementor-tab-title the7-accordion-header\" data-tab=\"2\" role=\"tab\" aria-controls=\"elementor-tab-content-2012\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Richiesta di rimborso<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-2012\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2012\"><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/11\/Richiesta-di-concessione-dei-contributi-della-spesa-per-la-modifica-degli-strumenti-di-guidaL.-5Febbaraio-1992-n.-104-art.-27-e-sue-s.m.i.pdf\" title=\"Concessione Contributi Alla Spesa Per Gli Strumenti Di Guida Per Adattamento Autoveicolo\" target=\"_blank\" rel=\"noopener\">Concessione contributi alla spesa per gli strumenti di guida per adattamento autoveicolo<\/a> (Legge 5 Febbraio 1992, n. 104, art. 27 e ss. mm) (2023)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2022\/11\/richiesta-rimborso-spese-soggetti-in-attesa-trapianto.pdf\" title=\"Spese Soggetti In Attesa Trapianto\" target=\"_blank\" rel=\"noopener\">Spese soggetti in attesa trapianto<\/a> (2024)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/domanda-rimborso-spese-pazienti-in-trattamento-dialitico-generico-2025.pdf\" title=\"Spese Pazienti In Trattamento Dialitico\" target=\"_blank\" rel=\"noopener\">Spese pazienti in trattamento dialitico<\/a> (2025)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2022\/11\/rimborso-per-trattamento-dialitico-domiciliare.pdf\" title=\"Trattamento Dialitico Domiciliare\" target=\"_blank\" rel=\"noopener\">Trattamento dialitico domiciliare<\/a> (2022)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-2013\" class=\"elementor-tab-title the7-accordion-header\" data-tab=\"3\" role=\"tab\" aria-controls=\"elementor-tab-content-2013\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Segnalazioni, reclami ed elogi<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-2013\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2013\"><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/01\/urp-scheda-segnalazioni-2025.pdf\" title=\"Modulo Per Segnalazioni\/reclami\" target=\"_blank\" rel=\"noopener\">Modulo per segnalazioni\/reclami<\/a> (2025)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dca0899 elementor-widget elementor-widget-the7-accordion\" data-id=\"dca0899\" data-element_type=\"widget\" data-widget_type=\"the7-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion the7-adv-accordion\" data-accordion-type=\"accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-2311\" class=\"elementor-tab-title the7-accordion-header deactive-default\" data-tab=\"1\" role=\"tab\" aria-controls=\"elementor-tab-content-2311\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Assistenza domiciliare\/residenziale e valutazioni multidimensionali<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-2311\" class=\"elementor-tab-content elementor-clearfix deactive-default\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2311\"><p>[.pdf]\u00a0 <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/01\/1-modello-431-attivazione-adi-rsa-2026.pdf\" title=\"Modello 431 \u2013 Attivazione ADI \/ RSA\" target=\"_blank\" rel=\"noopener\">Modello 431 &#8211; attivazione ADI \/ RSA<\/a> (2026)<\/p><p>[.pdf]\u00a0 <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/01\/cad-modulo-richiesta-RSA-caregiver-integrazione-431-2026.pdf\" title=\"Modulo Richiesta RSA \u2013 Integrazione Mod. 431\" target=\"_blank\" rel=\"noopener\">Modulo richiesta RSA &#8211; integrazione mod. 431<\/a> (2026)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/01\/2-delega-per-richiesta-ADI-2026.pdf\" title=\"Delega Per Richiesta ADI\" target=\"_blank\" rel=\"noopener\">Delega per richiesta ADI<\/a> (2026)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/01\/3-cad-consenso-dati-personali-e-privacy-2026.pdf\" title=\"Consenso Dati Personali E Privacy\" target=\"_blank\" rel=\"noopener\">Consenso dati personali e privacy<\/a> (2026)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/04\/cad-4-modulo-consenso-scelta-erogatore-ADI-2026.pdf\" title=\"Modulo Consenso Informato Scelta Erogatore ADI\" target=\"_blank\" rel=\"noopener\">Modulo consenso informato scelta erogatore ADI<\/a> (2026)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/01\/5-modulo-consenso-informato-al-trattamento-adi-cad-2026.pdf\" title=\"Modulo Consenso Informato Al Trattamento Domiciliare ADI \/ CAD\" target=\"_blank\" rel=\"noopener\">Modulo consenso informato al trattamento domiciliare ADI \/ CAD<\/a> (2026)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/01\/6-accettazione-PAI-con-informativa-2026.pdf\" title=\"Accettazione Piano Assistenza Individuale (PAI)\" target=\"_blank\" rel=\"noopener\">Accettazione Piano Assistenza Individuale (PAI)<\/a> (2026)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/01\/modulo-richiesta-attivazione-cure-palliative-2026.pdf\" title=\"Modulo Richiesta Attivazione Cure Palliative\" target=\"_blank\" rel=\"noopener\">Modulo richiesta attivazione cure palliative<\/a> (2026)<\/p><p>[.pdf]\u00a0 <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/01\/modulo-richiesta-inserimento-rsa-mantenimento-allegato7-sett2026.pdf\" title=\"Allegato 7: Modulo Richiesta Inserimento RSA \u2013 Mantenimento\" target=\"_blank\" rel=\"noopener\">Allegato 7: Modulo richiesta inserimento RSA &#8211; mantenimento<\/a> (2026)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-2312\" class=\"elementor-tab-title the7-accordion-header\" data-tab=\"2\" role=\"tab\" aria-controls=\"elementor-tab-content-2312\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Assistenza protesica integrata<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-2312\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2312\"><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2022\/03\/assistenza-protesica-istanza-presidi-autocertificazione.pdf\" title=\"Autocertificazione\" target=\"_blank\" rel=\"noopener\">Autocertificazione<\/a> (2022)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2022\/03\/assistenza-protesica-delega-generica-marzo2022.pdf\" title=\"Delega Generica\" target=\"_blank\" rel=\"noopener\">Delega generica<\/a> (2022)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2022\/11\/assistenza-protesica-modello-extratariffario-101122.pdf\" title=\"Modello Extratariffario\" target=\"_blank\" rel=\"noopener\">Modello extratariffario<\/a> (2022)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/06\/modulo-materiale-consumo-extragara-2025.pdf\" title=\"Modulo Materiale Di Consumo Extragara\" target=\"_blank\" rel=\"noopener\">Modulo materiale di consumo extragara<\/a> (2025)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/10\/assistenza-protesica-modulo-ausili-udito-2025.pdf\" title=\"Modulo Prescrizione Ausili Per L\u2019udito\" target=\"_blank\" rel=\"noopener\">Modulo prescrizione ausili per l&#8217;udito<\/a> (2025)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/06\/modulo-prescrizione-ventiloterapia-2025.pdf\" title=\"Modulo Prescrizione Ventiloterapia\" target=\"_blank\" rel=\"noopener\">Modulo prescrizione ventiloterapia<\/a> (2025)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/10\/uosd-assistenza-protesica-piani-terapeutici-ausili-per-incontinenti-2004.pdf\" title=\"Piani Terapeutici Ausili Per Incontinenti\" target=\"_blank\" rel=\"noopener\">Piani terapeutici Ausili per incontinenti<\/a> (2023)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2022\/11\/assistenza-protesica-prescrizione-presidi-101122.pdf\" title=\"Prescrizione Presidi\" target=\"_blank\" rel=\"noopener\">Prescrizione Presidi<\/a> (2022)<\/p><p><span style=\"text-decoration: underline;\">Distretto di Guidonia<\/span><\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2022\/08\/istanza-presidi-ventiloterapia-distretto-guidonia2022.docx\" title=\"Istanza Presidi Ventiloterapia\" target=\"_blank\" rel=\"noopener\">Istanza presidi ventiloterapia<\/a>\u00a0(2022)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-2313\" class=\"elementor-tab-title the7-accordion-header\" data-tab=\"3\" role=\"tab\" aria-controls=\"elementor-tab-content-2313\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Cure primarie<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-2313\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2313\"><p><span style=\"text-decoration: underline;\">Distretto di Tivoli<\/span><\/p><p>[.docx] <a title=\"Delega\" role=\"link\" href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/02\/53_delega-distretto-tivoli-2024.docx\" target=\"\" rel=\"noopener\">Delega<\/a> (2024)<\/p><p>[.docx] <a title=\"Dichiarazione Sostitutiva Atto Notoriet\u00e0\" role=\"link\" href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/02\/52_dichiarazione-sostitutiva-atto-notoriet-distretto-tivoli-2024.docx\" target=\"\" rel=\"noopener\">Dichiarazione sostitutiva atto notoriet\u00e0<\/a> (2024)<\/p><p>[.docx] <a title=\"Dichiarazione Sostitutiva Certificazione\" role=\"link\" href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/02\/35_dichiarazione-sostitutiva-certificazione-distretto-tivoli-2024.docx\" target=\"\" rel=\"noopener\">Dichiarazione sostitutiva certificazione<\/a> (2024)<\/p><p>[.docx] <a title=\"Indicazioni Scelta\/revoca Medico O Pediatra\" role=\"link\" href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/02\/indicazioni-scelta-revoca-medico-o-pediatra-distretto-tivoli-2024.docx\" target=\"\" rel=\"noopener\">Indicazioni scelta\/revoca medico o pediatra<\/a>\u00a0(2024)<\/p><p>[.docx] <a title=\"Iscrizione Temporanea Non Residenti\" role=\"link\" href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/02\/41_iscrizione-temporanea-non-residenti-distretto-tivoli-2024.docx\" target=\"\" rel=\"noopener\">Iscrizione temporanea non residenti<\/a> (2024)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2ff98d0 elementor-widget elementor-widget-the7-accordion\" data-id=\"2ff98d0\" data-element_type=\"widget\" data-widget_type=\"the7-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion the7-adv-accordion\" data-accordion-type=\"accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-5031\" class=\"elementor-tab-title the7-accordion-header deactive-default\" data-tab=\"1\" role=\"tab\" aria-controls=\"elementor-tab-content-5031\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Medicina legale<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-5031\" class=\"elementor-tab-content elementor-clearfix deactive-default\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-5031\"><p>[.pdf] <a class=\"edac-removed-title\" href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/02\/medicina-legale-modulo-domanda-indennizzo-L-210.pdf\" title=\"Modulo Domanda Di Indennizzo L.210\" target=\"_blank\" rel=\"noopener\" data-original-outline=\"\" data-original-offset=\"\" data-original-color=\"\">Modulo domanda di indennizzo L.210<\/a> (2024)<\/p><p>[.pdf] <a class=\"edac-removed-title\" href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/06\/DOMANDA-DI-UNA-TANTUM-O-DI-ASSEGNO-REVERSIBILE-ex-L._210_92.pdf\" title=\"Domanda Di Una Tantum O Di Assegno Reversibilie Ex L. 210-92\" target=\"_blank\" rel=\"noopener\" data-original-outline=\"\" data-original-offset=\"\" data-original-color=\"\">Domanda di una tantum o di assegno reversibilie ex L. 210-92<\/a> (2025)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-5032\" class=\"elementor-tab-title the7-accordion-header\" data-tab=\"2\" role=\"tab\" aria-controls=\"elementor-tab-content-5032\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Patenti speciali<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-5032\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-5032\"><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2026\/04\/modulo-richiesta-copia-fascicolo-personale-patenti-speciali-2026.pdf\" title=\"Modulo Richiesta Copia Fascicolo Personale Patente Speciale\" target=\"_blank\" rel=\"noopener\">Modulo richiesta copia fascicolo personale patente speciale<\/a> (2026)<\/p><p>[.docx] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/patenti-modulo-autodichiarazione-aggto-7112025.docx\" title=\"Modulo Di Autodichiarazione Patente Speciale\" target=\"_blank\" rel=\"noopener\">modulo di autodichiarazione patente speciale<\/a> (2025)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2012\/04\/strutture_patenti_modello_epilessia.pdf\" title=\"Modello Di Certificazione Neurologica\" target=\"_blank\" rel=\"noopener\">Modello di certificazione neurologica<\/a>: Epilessia e crisi epilettiche, idoneit\u00e0 alla guida (2012)<\/p><p>Modulo per rilascio o rinnovo della patente di guida:<\/p><ul><li>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/01\/modello-certificato-ministeriale-da-compilare-a-cura-del-pneumologo-per-osas.pdf\" title=\"Malattie Respiratorie\" target=\"_blank\" rel=\"noopener\">malattie respiratorie<\/a> (2023)<\/li><li>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/01\/modulo-rinnovo-patente-per-diabete.pdf\" title=\"Paziente Diabetico, Gruppo 1 Patenti Cat A\/B\" target=\"_blank\" rel=\"noopener\">paziente diabetico, gruppo 1 patenti cat A\/B <\/a>(2023)<\/li><li>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/10\/certificato-diabetologico-gruppo2-2023.pdf\" title=\"Paziente Diabetico, Gruppo 2 Patenti Cat. Superiore\" target=\"_blank\" rel=\"noopener\">paziente diabetico, gruppo 2 patenti cat. Superiore<\/a> (2023)<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9466631 elementor-widget elementor-widget-the7-accordion\" data-id=\"9466631\" data-element_type=\"widget\" data-widget_type=\"the7-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion the7-adv-accordion\" data-accordion-type=\"accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-1551\" class=\"elementor-tab-title the7-accordion-header deactive-default\" data-tab=\"1\" role=\"tab\" aria-controls=\"elementor-tab-content-1551\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Intramoenia<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-1551\" class=\"elementor-tab-content elementor-clearfix deactive-default\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-1551\"><p>All. 1 &#8211; [.pdf]\u00a0<a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/10\/intramoenia-allegato1-autocertificazione-titoli-2023.pdf\" title=\"Autocertificazione Titoli\" target=\"_blank\" rel=\"noopener\"> Autocertificazione titoli<\/a> (2023)<\/p><p>All. 2 &#8211; [.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/03\/intramoenia-allegato2-autocertificazione-soggetti-terzi-2024.pdf\" title=\"Autocertificazione Soggetti Terzi\" target=\"_blank\" rel=\"noopener\">Autocertificazione soggetti terzi <\/a>(2024)<\/p><p>All. 3 &#8211; [.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/10\/intramoenia-allegato3-modulo-adesione-2023.pdf\" title=\"Modulo Adesione\" target=\"_blank\" rel=\"noopener\">Modulo adesione<\/a> (2023)<\/p><p>All. 4 &#8211; [.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/10\/intramoenia-allegato4-installazione-strumentazione-2023.pdf\" title=\"Installazione Strumentazione\" target=\"_blank\" rel=\"noopener\">Installazione strumentazione<\/a> (2023)<\/p><p>All. 5 &#8211; [.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/12\/ALLEGATO-5-Modulo-Convenzione-Azienda-Professionista-per-ALPI-12-2024.pdf\" title=\"Modulo Convenzione Azienda Professionista Per ALPI\" target=\"_blank\" rel=\"noopener\">Modulo convenzione azienda professionista per ALPI<\/a> (2024)<\/p><p>All. 7 &#8211; [.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/10\/intramoenia-allegato7-visite-domiciliari-2023.pdf\" title=\"Visite Domiciliari\" target=\"_blank\" rel=\"noopener\">Visite domiciliari<\/a> (2023)<\/p><p>All. 8 &#8211; [.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/03\/intramoenia-allegato8-modulo-accettazione-incarico-consulenza-2024.pdf\" title=\"Accettazione Incarico Consulenza\" target=\"_blank\" rel=\"noopener\">Accettazione incarico consulenza<\/a> (2024)<\/p><p>All. 9 &#8211; [.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/10\/intramoenia-allegato9-prospetto-b-2023.pdf\" title=\"Prospetto B\" target=\"_blank\" rel=\"noopener\">Prospetto B<\/a> (2023)<\/p><p>All. 10 &#8211; [.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/10\/intramoenia-allegato10-richiesta-Nulla-Osta-attivazione-attivita-2023.pdf\" title=\"Richiesta Nulla Osta Attivazione Attivit\u00c3\u00a0\" target=\"_blank\" rel=\"noopener\">Richiesta Nulla Osta attivazione attivit\u00e0<\/a> (2023)<\/p><p>All. 11 &#8211; [.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/06\/intramoenia-allegato11-fac-simile-richiesta-convenzione-art91-ccnl-2025.pdf\" title=\"Richiesta Convenzione Art. 91 CCNL\" target=\"_blank\" rel=\"noopener\">Richiesta convenzione art. 91 CCNL<\/a> (2024)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d7c8328 elementor-widget elementor-widget-the7-accordion\" data-id=\"d7c8328\" data-element_type=\"widget\" data-widget_type=\"the7-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion the7-adv-accordion\" data-accordion-type=\"accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-2261\" class=\"elementor-tab-title the7-accordion-header deactive-default\" data-tab=\"1\" role=\"tab\" aria-controls=\"elementor-tab-content-2261\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Coordinamento Locale Trapianti<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-2261\" class=\"elementor-tab-content elementor-clearfix deactive-default\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-2261\"><p>Modulistica per la segnalazione del potenziale donatore di cornea:<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/donatore-cornea-autorizzazione-autorita-giudiziaria.pdf\" title=\"Autorizzazione Autorit\u00c3\u00a0 Giudiziaria\" target=\"_blank\" rel=\"noopener\">Autorizzazione autorit\u00e0 giudiziaria<\/a> (2021)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/donatore-cornea-certificato-accertamento-strumentale.pdf\" title=\"Certificato Di Accertamento Strumentale\" target=\"_blank\" rel=\"noopener\">Certificato di accertamento strumentale<\/a> (2021)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/donatore-cornea-consenso-donazione.pdf\" title=\"Consenso Di Donazione\" target=\"_blank\" rel=\"noopener\">Consenso di donazione<\/a> (2021)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/donatore-cornea-modulo-constatato-decesso.pdf\" title=\"Constatato Decesso\" target=\"_blank\" rel=\"noopener\">Constatato decesso<\/a> (2021)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/donatore-cornea-informativa-prelievo-con-anamnesi-sociale.pdf\" title=\"Informativa Prelievo Con Anamnesi Sociale\" target=\"_blank\" rel=\"noopener\">Informativa prelievo con anamnesi sociale<\/a> (2021)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/donatore-cornea-procedura-prelievo.pdf\" title=\"Procedura Di Prelievo\" target=\"_blank\" rel=\"noopener\">Procedura di prelievo<\/a><\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/donatore-cornea-scheda-registro-decessi.pdf\" title=\"Scheda Registro Dei Decessi\" target=\"_blank\" rel=\"noopener\">Scheda registro dei decessi<\/a> (2021)<\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/05\/donatore-cornea-verbale-prelievo.pdf\" title=\"Verbale Di Prelievo\" target=\"_blank\" rel=\"noopener\">Verbale di prelievo<\/a><\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8fc0acc elementor-widget elementor-widget-the7-accordion\" data-id=\"8fc0acc\" data-element_type=\"widget\" data-widget_type=\"the7-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion the7-adv-accordion\" data-accordion-type=\"accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-1501\" class=\"elementor-tab-title the7-accordion-header deactive-default\" data-tab=\"1\" role=\"tab\" aria-controls=\"elementor-tab-content-1501\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Dipartimento di Prevenzione<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-1501\" class=\"elementor-tab-content elementor-clearfix deactive-default\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-1501\"><p>\u00a0<\/p><p>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2023\/10\/modello-esposti-e-segnalazioni-uoc-psll-2023.pdf\" title=\"Modello Di Segnalazione\/esposto A Tutela Della Salute E Sicurezza Dei Lavoratori\" target=\"_blank\" rel=\"noopener\">Modello di segnalazione\/esposto a tutela della salute e sicurezza dei lavoratori<\/a> (2023)<\/p><p><strong> UOC Tutela igienico sanitaria degli alimenti di origine animale (B)<\/strong><\/p><p>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello1-anagrafica-2025.pdf\" title=\"Modello 1 \u2013 Anagrafica\" target=\"_blank\" rel=\"noopener\">Modello 1 &#8211; Anagrafica<\/a> (2025)<br \/>[pdf] Modello 2 &#8211; <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello2-determina-G18977-291222-riconoscimento.pdf\" title=\"Determina G18977 Del 29\/12\/22\" target=\"_blank\" rel=\"noopener\">Determina G18977 del 29\/12\/22<\/a> -Riconoscimento<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello3-istanza-Riconoscimento-2025.pdf\" title=\"Modello 3 \u2013 Istanza Riconoscimento\" target=\"_blank\" rel=\"noopener\">Modello 3 &#8211; Istanza riconoscimento<\/a> (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello4-riconoscimento-ampliamento-2025.pdf\" title=\"Modello 4 \u2013 Riconoscimento Ampliamento\" target=\"_blank\" rel=\"noopener\">Modello 4 &#8211; Riconoscimento ampliamento<\/a> (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello5-riconoscimento-schedaB-2025.pdf\" title=\"Modello 5 \u2013 Riconoscimento Scheda B\" target=\"_blank\" rel=\"noopener\">Modello 5 &#8211; Riconoscimento scheda B<\/a> (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello6-riconoscimento-voltura-2025.pdf\" title=\"Modello 6 \u2013 Riconoscimento Voltura\" target=\"_blank\" rel=\"noopener\">Modello 6 &#8211; Riconoscimento voltura<\/a> (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello7-riconoscimento-modifica-strutturale-2025.pdf\" title=\"Modello 7 \u2013 Riconoscimento Modifica Strutturale E\/o Impiantistica\" target=\"_blank\" rel=\"noopener\">Modello 7 &#8211; Riconoscimento modifica strutturale e\/o impiantistica<\/a> (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello8-riconoscimento-cessazione-sospensione-2025.pdf\" title=\"Modello 8 \u2013 Riconoscimento Cessazione\/sospensione\" target=\"_blank\" rel=\"noopener\">Modello 8 &#8211; Riconoscimento cessazione\/sospensione<\/a> (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello9-modulo-richiesta-pareri-OSA-2025.pdf\" title=\"Modello 9 \u2013 Modulo Richiesta Pareri OSA\" target=\"_blank\" rel=\"noopener\">Modello 9 &#8211; Modulo richiesta pareri OSA<\/a> (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello10-istruzioni-operative-controperizia-e-controversia-2025.pdf\" title=\"Modello 10 \u2013 Istruzioni Operative Controperizia E Controversia\" target=\"_blank\" rel=\"noopener\">Modello 10 &#8211; Istruzioni operative controperizia e controversia<\/a> (2025)<br \/>[docx] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modello11-accesso-agli-atti-2025.docx\" title=\"Modello 11 \u2013 Accesso Agli Atti\" target=\"_blank\" rel=\"noopener\">Modello 11 &#8211; Accesso agli atti<\/a> (2025)<\/p><p>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-comunicazione-macellazione-suini-2025.pdf\" title=\"Comunicazione Macellazione Suini\" target=\"_blank\" rel=\"noopener\">Comunicazione macellazione suini<\/a> (2025)<br \/>[docx] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-dichiarazione-atto-notorieta-e-privacy-specie-suina-2025.docx\" target=\"_blank\" rel=\"noopener\">Dichiarazione atto notoriet\u00e0 e privacy<\/a> &#8211; specie suina (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-dichiarazione-atto-notorieta-e-privacy-specie-tutte-le-specie-2025.pdf\" title=\"Dichiarazione Atto Notoriet\u00c3\u00a0 E Privacy\" target=\"_blank\" rel=\"noopener\">Dichiarazione atto notoriet\u00e0 e privacy<\/a> &#8211; tutte le specie (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-modulo-restituzione-marche-auricolari-tutte-le-specie-2025.pdf\" title=\"Modulo Restituzione Marche Auricolari\" target=\"_blank\" rel=\"noopener\">Modulo restituzione marche auricolari<\/a> &#8211; tutte le specie (2025)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/11\/uoc-tutela-igienico-sanitaria-oa-richiesta-macellazione-a-domicilio-tutte-le-specie-2025.pdf\" title=\"Richiesta Macellazione A Domicilio\" target=\"_blank\" rel=\"noopener\">Richiesta macellazione a domicilio<\/a> &#8211; tutte le specie (2025)<\/p><p><strong>Anagrafe animali d&#8217;affezione<\/strong><\/p><p>[pdf] Modello A &#8211; <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/10\/animali-affezione-modelloA-riconoscimento-colonia-felina-2023.pdf\" title=\"Riconoscimento Colonia Felina\" target=\"_blank\" rel=\"noopener\">Riconoscimento colonia felina<\/a> (2023)<br \/>[pdf] Modello B (da allegare al modello A) &#8211; <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/10\/animali-affezione-modelloB-vademecum-referente-colonia-felina-2023.pdf\" title=\"Vademecum Del Referente Di Colonia Felina\" target=\"_blank\" rel=\"noopener\">Vademecum del referente di colonia felina<\/a> (2023)<br \/>[pdf] Modello C &#8211; <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/10\/animali-affezione-modelloC-richiesta-sterilizzazione-colonia-felina-2023.pdf\" title=\"Richiesta Di Sterilizzazione Colonia Felina\" target=\"_blank\" rel=\"noopener\">Richiesta di sterilizzazione colonia felina<\/a> (2023)<br \/>[pdf] Modello D &#8211; <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/10\/animali-affezione-modelloD-comunicazione-variazione-referente-colonia-felina-2023.pdf\" title=\"Comunicazione Variazione Referente Di Colonia Felina\" target=\"_blank\" rel=\"noopener\">Comunicazione variazione referente di colonia felina<\/a> (2023)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/10\/animali-affezione-modello-richiesta-passaporto-PET-2023.pdf\" title=\"Modello Richiesta Passaporto PET\" target=\"_blank\" rel=\"noopener\">Modello richiesta passaporto PET<\/a> (2023)<br \/>[pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2025\/10\/animali-affezione-modello-variazioni-anagrafe-canina-2023.pdf\" title=\"Modello Variazioni Anagrafe Canina\" target=\"_blank\" rel=\"noopener\">Modello variazioni anagrafe canina<\/a> (2023)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6d63e80 elementor-widget elementor-widget-the7-accordion\" data-id=\"6d63e80\" data-element_type=\"widget\" data-widget_type=\"the7-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion the7-adv-accordion\" data-accordion-type=\"accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t<div class=\"elementor-accordion-item\">\n\t\t\t\t\t<h4 id=\"elementor-tab-title-1141\" class=\"elementor-tab-title the7-accordion-header deactive-default\" data-tab=\"1\" role=\"tab\" aria-controls=\"elementor-tab-content-1141\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon elementor-accordion-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-closed\"><i class=\"fas fa-caret-down\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-accordion-icon-opened\"><i class=\"fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-accordion-title\" href=\"\">Amministrazione Trasparente<\/a>\n\t\t\t\t\t<\/h4>\n\t\t\t\t\t<div id=\"elementor-tab-content-1141\" class=\"elementor-tab-content elementor-clearfix deactive-default\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-1141\"><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2024\/01\/accesso_civico_generalizzato-090124.pdf\" title=\"Istanza Di Accesso Civico E Documentale\" target=\"_blank\" rel=\"noopener\">Istanza di accesso civico e documentale<\/a> (2024)<\/p><p><span style=\"text-decoration: underline;\">Dichiarazione di inconferibilit\u00e0 e incompatibilit\u00e0<\/span><\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/07\/dichiarazione-incompatibilita-inconferibilita.pdf\" title=\"Informativa\" target=\"_blank\" rel=\"noopener\">Informativa<\/a><\/p><p>[.pdf] <a href=\"https:\/\/www.aslroma5.it\/wp-content\/uploads\/2021\/07\/modello-dichiarazione-incompatibilita-inconferibilita.pdf\" title=\"Modulo\" target=\"_blank\" rel=\"noopener\">Modulo<\/a> (2021)<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u00c8 possibile scaricare la modulistica utile per accedere ai servizi della ASL Roma 5. Sezione relativa alle tipologie di procedimento, come indicato all&#8217;art. 35, c. 1,2 del d.lgs. 33\/2013 Moduli generici [.pdf] Assistenza sanitaria ai cittadini comunitari (2010) [.pdf] Astensione anticipata dal lavoro per gravidanze a rischio (2012) [.pdf] Autocertificazione ai fini dell&#8217;esenzione dalla partecipazione&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":19,"comment_status":"open","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-13799","page","type-page","status-publish","hentry"],"acf":{"galleria":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Modulistica - ASL ROMA 5<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.aslroma5.it\/modulistica\/\" \/>\n<meta property=\"og:locale\" content=\"it_IT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Modulistica - ASL ROMA 5\" \/>\n<meta property=\"og:description\" content=\"\u00c8 possibile scaricare la modulistica utile per accedere ai servizi della ASL Roma 5. 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