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‫ﺗ ﻘ ﺮﻳ ﺮ إ ﺟﺎ زة ﻣ ﺮ ﺿﻴ ﺔ‬

Sick Leave
Report
GSL22012743344

MOH states that patient ‫ﻳ ﻔﻴ ﺪ و زا ر ة اﻟ ﺼ ﺤ ﺔ ﺑﺄ ن اﻟ ﻤ ﺮﻳ ﺾ‬

Holder of ID number 1121342552 1121342552 ‫ﺻﺎﺣﺐ اﻟﻬﻮﻳﺔ رﻗﻢ‬

has been given a sick leave report for 7 of days ‫ ﻣ ﻦ ا ﻷﻳﺎ م‬7 ‫ﻗ ﺪ ﻣﻨ ﺢ إ ﺟﺎ ز ة ﻣ ﺮ ﺿﻴ ﺔ ل‬

from 01/27/2022 00:00:00 01/27/2022 00:00:00 ‫ﻣﻦ ﺗﺎرﻳﺦ‬

to 02/02/2022 00:00:00 02/02/2022 00:00:00 ‫إﻟﻰ ﺗﺎرﻳﺦ‬

Patient’s Information ‫ﺑﻴﺎﻧﺎ ت اﻟ ﻤ ﺮﻳ ﺾ‬

Medical record number: 11213425520190019881 11213425520190019881 :‫رﻗﻢ اﻟﺴﺠﻞ اﻟﻄﺒﻲ‬

National ID Number: 1121342552 1121342552 : ‫ اﻹﻗﺎﻣﺔ‬/ ‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ‬

Full Name: YAZAN YAHYA MOKARAB FAEA ‫ ﻳ ﺰ ن ﻳ ﺤﻴ ﻰ ﻣ ﺨ ﺮ ب ﻓﺎﺋ ﻊ‬:‫ا ﻻ ﺳ ﻢ اﻟ ﻜﺎ ﻣ ﻞ‬

Sick Leave Date: 01/27/2022 00:00:00 01/27/2022 00:00:00 : ‫ﺗﺎرﻳﺦ اﻹﺟﺎزة‬

Gender: ‫ذﻛﺮ‬ ‫ذ ﻛ ﺮ‬:‫اﻟ ﺠﻨ ﺲ‬

Date of Birth: 2003-07-22 22-07-2003 :‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬

Nationality:900 900:‫اﻟﺠﻨﺴﻴﺔ‬

Employer: ‫ﺟﻬﺔ اﻟﻌﻤﻞ‬: -

Occupation: ‫اﻟﻤﻬﻨﺔ‬: -

Visit Date:: 01/27/2022 00:00:00 01/27/2022 00:00:00 : ‫ﺗﺎرﻳﺦ اﻟﺪﺧﻮل‬

Discharge Date: 01/27/2022 00:00:00 01/27/2022 00:00:00 : ‫ﺗﺎرﻳﺦ اﻟﺨﺮوج‬

Recommendation ‫اﻟﺘ ﻮ ﺻﻴﺎ ت‬

Sick Leave for 7 days ‫ أﻳﺎ م‬7 ‫ﺗ ﻢ ﻣﻨ ﺤ ﻪ إ ﺟﺎ ز ة ﻣ ﺮ ﺿﻴ ﺔ ﻟ ﻤ ﺪ ة‬

From: 01/27/2022 00:00:00 01/27/2022 00:00:00 : ‫ﻣﻦ ﺗﺎرﻳﺦ‬

To: 02/02/2022 00:00:00 02/02/2022 00:00:00 : ‫ﺣﺘﻰ ﺗﺎرﻳﺦ‬

01/27/2022 00:00:00 : ‫ﻣﺮاﺟﻌﺔ اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ ﻗﺒﻞ اﻧﺘﻬﺎء‬

Consultation Date: 01/27/2022 00:00:00
‫إ ﺟﺎ زﺗ ﻪ‬

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Attending Physician Information ‫ﺑﻴﺎﻧﺎ ت اﻟ ﻄﺒﻴ ﺐ اﻟ ﻤ ﻌﺎﻟ ﺞ‬

Name: ABDULLAH MUFAREH ALI ASSIRI ‫ ﻋ ﺒ ﺪا ﻟ ﻠ ﻪ ﻣ ﻔ ﺮ ح ﻋ ﻠ ﻲ ﻋ ﺴ ﻴ ﺮ ي‬: ‫ا ﻻ ﺳ ﻢ‬

Position: ‫ا ﺳ ﺘ ﺸ ﺎ ر ي‬: ‫ا ﻟ ﻤ ﺴ ﻤ ﻰ ا ﻟ ﻮ ﻇ ﻴ ﻔ ﻲ‬

Physician Information ‫ﺑﻴﺎﻧﺎ ت اﻟ ﻄﺒﻴ ﺐ اﻟ ﻤﻨﺎ و ب‬

Name: ‫ اﻻ ﺳﻢ‬:

Position: ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬:

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