CERTIFICAT

MEDICAL

Domnul (doamna) ___________________________________ nscut() la

data de _______________________ fiul (fiica) lui ____________________
i al _________________________ domiciliat () n __________________
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BI / CI seria nr Eliberat de .
EXAMENE MEDICALE :
1. RADIOLOGIE PULMONAR _______________________________
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2. EXAMENUL SNGELUI ___________________________________
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3. EXAMENUL PSIHIATRIC __________________________________
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4. ALTE EXAMENE : ________________________________________
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ESTE SUFERIND DE : ________________________________________
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SE RECOMAND : ___________________________________________
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CONCLUZII: SOLICITANTUL ESTE APT / INAPT DE A LUCRA N
NVMNT NEEXISTND/EXISTND INCOMPATIBILITI
DE ORDIN MEDICAL CU FUNCIA DIDACTICA
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S-A ELIBERAT PREZENTA SPRE A-I SERVI LA NCADRAREA
NTR-O FUNCIE DIDACTIC.
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SEMNTURA I PARAFA MEDICULUI DE FAMILIE/

MEDICULUI DE MEDICINA MUNCII