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開設届出事項一部変更届（医療業務従事者変更用）
healthadminother
This form is submitted when changing the establishment permit details of a clinic (midwife facility). It covers changes to medical staff such as physicians, dentists, midwives, pharmacists, and staff numbers, and requires attachment of relevant documents. It is submitted to the Head of the Itabashi Ward Health Center.
| What | 診療所（助産所）の開設許可に関する事項の変更届出 |
|---|---|
| Who | 診療所（助産所）の開設者（経営者） |
| When | 記載なし |
| Where | 板橋区保健所長 |
| How | 開設許可（届出）事項を変更した旨を記載し、必要書類（免許証写し、本人確認書類等）を添付して提出する |
| Deadline | 記載なし |
| Contact | 電話番号: 記載なし, ファクシミリ番号: 記載なし |
Open the original PDF ↗ 3 pages
Source page: https://www.city.itabashi.tokyo.jp/kenko/eisei/1015896/1016031/1015956.html
Checked 2026-10-09. This page restates the PDF in a fixed structure; nothing is added or removed. Where the PDF does not say, the field reads "not stated". The original Japanese PDF is authoritative — confirm dates and conditions there.