Sunteți pe pagina 1din 2

SPITAL CLINIC DE OBSTETRICA-GINEOLOGIE “ELENA DOAMNA ‘ IASI

STR.El.Doamna nr.49,Iasi-700398,Romania
Tel.0232210390,fax 0232210396
Sp_elenadoamna@hih.ro,elenadoamna@adslexpress.ro

Nr.inregistrare____________

CNP_______________________

ADEVERINTA MEDICALA

Se adevereste ca ____________________________________________
Nascut:anul_________luna_______________ziua__________________
Cu domiciliul in :judetul______________localitatea_________________
Str._______________________nr.____bl._____sc._____ap.__________
Avand ocupatia:______________________________________________

Este suferind de:_____________________________________________


Se recomanda_______________________________________________

S-a eliberat prezenta spre a-I servi la_____________________________

Data eliberarii: Semnatura si parafa medicului


Anul_____luna________ziua_____ L.S._____________________

SPITAL CLINIC DE OBSTETRICA-GINEOLOGIE


Nr.inregistrare____________
“ELENA DOAMNA ‘ IASI CNP___________________________
STR.El.Doamna nr.49,Iasi-700398,Romania
Tel.0232210390,fax 0232210396
Sp_elenadoamna@hih.ro,elenadoamna@adslexpress.ro

ADEVERINTA MEDICALA

Se adevereste ca ____________________________________________
Nascut:anul_________luna_______________ziua__________________
Cu domiciliul in :judetul______________localitatea_________________
Str._______________________nr.____bl._____sc._____ap.__________
Avand ocupatia:______________________________________________

Este suferind de:_____________________________________________


Se recomanda_______________________________________________

S-a eliberat prezenta spre a-I servi la_____________________________

Data eliberarii: Semnatura si parafa medicului


Anul_____luna________ziua_____ L.S._____________________
Concluziile examenului medical de bilant_____________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Rezulatul investigatiilor medicale:

Radiologie pulmonara_____________________________________________________________

Serologia sifilisului________________________________________________________________

Recomandari:_______________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Apt pentru:_________________________________________________________________________

__________________________________________________________________________________

Concluziile examenului medical de bilant_____________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Rezulatul investigatiilor medicale:

Radiologie pulmonara_____________________________________________________________

Serologia sifilisului________________________________________________________________

Recomandari:_______________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Apt pentru:_________________________________________________________________________

S-ar putea să vă placă și