Nr.

de nregistrare:
Data eliberrii:

EXTRAS MEDICAL DE LA DOMICILIU

n legtur cu participarea la concursul pentru ocuparea funciei de procuror, se
solicit certificatul medical pentru concurentul _______________________________
(nume, prenume, anul naterii,

_____________________________________________________________________
domiciliul)

Medicul de familie:

Medicul_______________________________L..___________________________

Medicul narcolog:

Medicul psihiatru:

Prin prezentul se confirm, c cet.____________

Prin prezentul se confirm, c cet.____________

_________________________________

_________________________________

La eviden narcologic____________________
_______________________________________
_______________________________________
Medicul_______________L..____________

La eviden la psihiatru____________________
_______________________________________
_______________________________________
Medicul_______________L..____________

Medicul ftiziolog:

Medicul infecionist

Prin prezentul se confirm, c cet.____________

Prin prezentul se confirm, c cet.____________

_________________________________

_________________________________

La eviden la ftiziolog____________________
_______________________________________
_______________________________________
Medicul_______________L..____________

La eviden la infecoinist__________________
_______________________________________
_______________________________________
Medicul_______________L..____________

eful policlinicii
L..____________

_________________