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Maal yal lajlig HE, H a P..H.C. DIRECTORATE ees venn ah SY) Ag) Ayal Aye 5 a} ‘Trubah P .H.C.C. (eyo Blame at ji Magna Ag Apaecll Ale Hj ya SICK LEAVE REPORT Patient Name ] ID Record No: Sex: Mo Fo Nationality : Saudi | 1 = | Place of Work > — Date of Visit : Adm. Date: | Discharge Date : Following medical examination, it is recommended gees Uaayall gle lll Atl 1 Sick leave(one) Day (8) Mad (pnp) AS Bad Aye ya bj! Aad] Starting from // To SVEN V/eE/N9 zon Lise) (1) LE 1 Follow up before end sick leave . e en . Referral to Medical Committee for following aoe Dee ASD eat sary Aaladl Aadlatl Aig le aca 1c Approval of sick leave. cgi fat ace] c Can not be treated at this facility. open dQ (Saal) 2 oa) E cae or partial disability. Fpl J istie bige pucll ote oe US td +a SIR] oi______—si)_ Recommendation Treating Physician Name : Signature: Badge No: a i Physician Name : sheets |: call yall pel Signature: y > 2 AU dana Ye I 56 ya yd Guat Approval by the Director of Turba P.H.C.C: fe a ‘Name eee ee Signature: Date: = / / VErv/e/\4 + yt SH VENV/O/\4 Gishill gad -polipll po jaall Sila ctciateal 45 yt / yay © aa yyy BI dan yy ole 2s L Aaa ceagall Ae cya ESN oly AV ETY/ fgets gy pills) 5 LD) Age tt Sel dae aga) @Spsh pd) — Adel / AQ la) Aiba i gal deal yo 05 32} 7] dip ey Ca verve: util

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