Scribd Logo
Upload

Welcome to Scribd!

  • علاج

    Uploaded by

    Moh Hassan
    17 views1 page

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    17 views1 page

    علاج

    Uploaded by

    Moh Hassan

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    ‫نموذج طلب عالج‬

    ‫التاريخ‪:‬‬

    ‫الوظيفة‪:‬‬ ‫اسم املوظف‪:‬‬

    ‫شكوى املريض ‪:‬‬ ‫العيادة احملال إليها املريض‪:‬‬

    ‫اخلتم الرمسي‬ ‫املدير العام‬ ‫املدير املباشر‬

    ‫الستعمال الطبيب المعالج‬

    ‫العيادة اليت عوجل هبا املريض ‪ ....................................‬تاريخ املراجعة ‪2014 / / :‬‬

    ‫التشخيص وتوصيات الطبيب ‪:‬‬


    ‫‪.............................................................................................‬‬
    ‫‪.............................................................................................‬‬
    ‫‪.............................................................................................‬‬
    ‫‪.............................................................................................‬‬
    ‫‪.............................................................................................‬‬
    ‫توقيع الطبيب وختمه‬

    You might also like