Anexa nr.

2
la Regulamentul cu privire la verificarea strii de sntate
a candidailor la funcia de judector i a judectorilor n funcie privind
corespunderea pentru exercitarea funciei de judector

CERTIFICAT MEDICAL
privind starea sntii a candidailor la funcia de judector i a
judectorilor n funcie privind corespunderea pentru
exercitarea funciei de judector
Numele, prenumele __________ _______ _______________ ____________
Data naterii___________________________________________________
Locul de munc, funcia _____________________________ ____________
Concluzii privind starea sntii (diagnosticul, codificare): __________________
__________________________________________________________________
______________________________________________________________
_______________________________________________________________
Concluzie privind corespunderea pentru exercitarea funciei de judector
________________________________________________________________
Medicii, membrii Comisiei de contestaie
Numele, prenumele
Profilul medical

Preedintele Comisiei de contestaie: _________________

(numele, prenumele, semntura)
Data _______________________

Semntura

Datele examenului medical

Psihiatru ________________________________________________________
_______________________________________________________________
_________________________________________________________
Narcolog __________________________________________________
_________________________________________________________
_________________________________________________________
Neurolog _______________________________________________________
_______________________________________________________________
Terapeut ___________________________________________________
__________________________________________________________
Semntura preedintelui Comisiei de contestaie________________________