‫ﺗﻘﺮﻳﺮ إﺟﺎزة ﻣﺮﺿﻴﺔ‬

Sick Leave
Report
1128282
(tel:1128282)

King Fahd Primary Health Care Center ‫ﻳﻔﻴﺪ ﻣﺮﻛﺰ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ اﻻوﻟﻴﺔ اﻟﻤﻠﻚ ﻓﻬﺪ‬
states that patient HANAN MOHAMMED ‫ﺑﺄن اﻟﻤﺮﻳﺾ ﺣﻨﺎن ﻣﺤﻤﺪ ﻋﺒﺪاﻟﻠﻪ اﻟﻨﺎﻳﻞ ﺻﺎﺣﺐ‬
ABDULLAH ALNAIL Holder of ID Number tel:1112157233)
tel:1112157233))) 1112157233 ‫اﻟﻬﻮﻳﺔ رﻗﻢ‬
1112157233 (tel:1112157233) has been - 1441 ‫ ﻣﻦ اﻷﻳﺎم ﻣﻦ ﺗﺎرﻳﺦ‬1 ‫ﻗﺪ ﻣﻨﺢ إﺟﺎزة ﻣﺮﺿﻴﺔ ل‬
given a sick leave report for 1 of days from : ‫ ﺣﺴﺐ اﻟﺘﺎﻟﻲ‬12
12--01
01--1441 ‫ إﻟﻰ ﺗﺎرﻳﺦ‬12
12--01
2019-09-11 to 2019-09-11

Patient’s Information ‫ﺑﻴﺎﻧﺎت اﻟﻤﺮﻳﺾ‬

Medical Record Number: 0 0 : ‫رﻗﻢ اﻟﺴﺠﻞ اﻟﻄﺒﻲ‬
1112157233 : ‫ اﻹﻗﺎﻣﺔ‬/ ‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ‬
National ID Number : 1112157233 (tel:1112157233)
(tel:1112157233)
Full Name : HANAN MOHAMMED ABDULLAH ALNAIL ‫ ﺣﻨﺎن ﻣﺤﻤﺪ ﻋﺒﺪاﻟﻠﻪ اﻟﻨﺎﻳﻞ‬: ‫اﻻﺳﻢ اﻟﻜﺎﻣﻞ‬
Sick Leave Date : 2019-09-15 16-01-1441 : ‫ﺗﺎرﻳﺦ اﻻﺟﺎزة‬
Gender :Female ‫ أﻧﺜﻰ‬: ‫اﻟﺠﻨﺲ‬
Date of Birth : 2000-02-05 29-10-1420 : ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬
Nationality : Saudi Arabia ‫ اﻟﺴﻌﻮدﻳﺔ‬: ‫اﻟﺠﻨﺴﻴﺔ‬
Employer : ‫ ﺟﺎﻣﻌﺔ اﻻﻣﻴﺮة ﻧﻮرة ﺑﻨﺖ ﻋﺒﺪاﻟﺮﺣﻤﻦ‬: ‫ﺟﻬﺔ اﻟﻌﻤﻞ‬
Occupation : ‫ ﻃﺎﻟﺒﺔ‬: ‫اﻟﻤﻬﻨﺔ‬
Visit Date :2019-09-11 12-01-1441 : ‫ﺗﺎرﻳﺦ اﻟﺪﺧﻮل‬
Discharge Date : 2019-09-11 12-01-1441 : ‫ﺗﺎرﻳﺦ اﻟﺨﺮوج‬
Revisit Date : 2019-09-11 12-01-1441 : ‫ﺗﺎرﻳﺦ اﻟﻤﺮاﺟﻌﺔ‬
Recommendation ‫اﻟﺘﻮﺻﻴﺎت‬
Sick Leave for 1 days ‫ أﻳﺎم‬1 ‫ﺗﻢ ﻣﻨﺤﻪ إﺟﺎزة ﻣﺮﺿﻴﺔ ﻟﻤﺪة‬
From :2019-09-11 12-01-1441 : ‫ﻣﻦ ﺗﺎرﻳﺦ‬
To : 2019-09-11 12-01-1441 : ‫ﺣﺘﻰ ﺗﺎرﻳﺦ‬
Consultation Date : : ‫ﻣﺮاﺟﻌﺔ اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ ﻗﺒﻞ اﻧﺘﻬﺎء إﺟﺎزﺗﻪ‬
Attending Physician Information ‫ﺑﻴﺎﻧﺎت اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ‬
Name : NADIYAH FARUQ ALSAYED A ‫ ﻧﺎدﻳﺔ ﻓﺎروق اﻟﺴﻴﺪ ﺟﻨﻴﻨﺔ‬: ‫اﻻﺳﻢ‬
Position : Registrar ‫ ﻧﺎﺋﺐ‬: ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬
Alternate Physician Information ‫ﺑﻴﺎﻧﺎت اﻟﻄﺒﻴﺐ اﻟﻤﻨﺎوب‬
Name : : ‫اﻻﺳﻢ‬
Position : : ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬