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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
______________________________