Adeverinta Medicala Pentru Inscrierea La Facultate
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Transcript of Adeverinta Medicala Pentru Inscrierea La Facultate
Adeverinta medicala pentru inscrierea la facultate
Adeverinta medicala pentru
inscrierea la facultate
Judetul _________________________Nr. carnet sanatate _______________Localitatea ______________________Unitatea sanitara _________________ADEVERINTA MEDICALA
Se adevereste ca _______________________________________________________ , sexul M / F, data nasterii: anul ____ luna ____ ziua _____ , domiciliat/a in localitatea _______________ , judetul _______________ , adresa _____________________________________________________________
Se afla in evidenta noastra suferind de:
___________________________________________________________________________________
Concluziile examenului medical:
___________________________________________________________________________________
___________________________________________________________________________________
Rezultatul examenului medical:
- radiologia pulmonara
___________________________________________________________________________________
- serologia sifilisului
_________________________________________________________________________________
- examen psihiatric
___________________________________________________________________________________
- examen cardiologic
___________________________________________________________________________________
I s-a eliberat prezenta pentru a folosi la
_________________________________________________________________________________________________
Data eliberarii:Ziua ____ luna ____ anul _____
Semnatura si parafa medicului
______________________________