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Certificat

despre starea sntii elevului


1.Numele i pronumele elevului___________________________________________________
2.Vrsta i clasa________________________________________________________________
3.Denumirea instituiei de nvmnt______________________________________________
4.Adresa domiciliului___________________________________________________________
5.Dezvoltarea fizic a elevului: talia _________
greutatea:___________________________
Diagnoza i recomandrile medicilor specialiti:
- Oftalmologul__________________________________________________________
- Otorinoloringologul_____________________________________________________
- Chirurg-ortoped________________________________________________________
- Stomatologul__________________________________________________________
- Genicologul___________________________________________________________
- Medicul de familie______________________________________________________
Grupa de sntate_________________________________________________________
Grupa la educaia fizica_____________________________________________________
Data

Semntura

Certificat
despre starea sntii elevului
1.Numele i pronumele elevului___________________________________________________
2.Vrsta i clasa________________________________________________________________
3.Denumirea instituiei de nvmnt______________________________________________
4.Adresa domiciliului___________________________________________________________
5.Dezvoltarea fizic a elevului: talia _________
greutatea:___________________________
Diagnoza i recomandrile medicilor specialiti:
- Oftalmologul__________________________________________________________
- Otorinoloringologul_____________________________________________________
- Chirurg-ortoped________________________________________________________
- Stomatologul__________________________________________________________
- Genicologul___________________________________________________________
- Medicul de familie______________________________________________________
Grupa de sntate_________________________________________________________
Grupa la educaia fizica_____________________________________________________
Data

Semntura