‫‪5.

01‬‬ ‫ﺍﻟﻮﻗﺖ‪:‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺘﺮﺑﻴﺔ‬

‫‪2023/10/18‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ ‪:‬‬ ‫ﺍﻹﺩﺍﺭﺓ ﺍﻟﻌﺎﻣﺔ ﻟﻤﻨﻄﻘﺔ ﺍﻷﺣﻤﺪﻱ ﺍﻟﺘﻌﻠﻴﻤﻴﺔ‬
‫ﻫﺸﺎﻡ ﺑﻦ ﺍﻟﻌﺎﺹ ﺍﻟﺜﺎﻧﻮﻳﺔ ﻟﻠﺒﻨﻴﻦ‬

‫ﺗﺤﻮﻳﻞ ﻃﺒـﻲ‬
‫ﻋﺒﺪﺍﻟﻌﺰﻳﺰ ﻋﺒﺪﺍﻟﻠﻪ ﺻﺎﻟﺢ ﺍﻟﺴﻬﻠﻲ‬ ‫ﺍﺳﻢ ﺍﻟﻄﺎﻟﺐ ‪:‬‬

‫‪306090101033‬‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﻤﺪﻧﻲ ‪:‬‬

‫‪7‬‬ ‫‪/‬‬ ‫ﺍﻟﺼﻒ ﺍﻟﺜﺎﻧﻲ ﻋﺸﺮ ‪ -‬ﻋﻠﻤﻲ‬ ‫ﺍﻟﺼﻒ ﺍﻟﺪﺭﺍﺳﻲ ﻭﺍﻟﻔﺼﻞ ‪:‬‬

‫ﺍﻟﺴﻴﺪ ﺍﻟﻤﺤﺘﺮﻡ ﺍﻟﻄﺒﻴﺐ ﺍﻟﻤﻌﺎﻟﺞ ‪ ،،،/‬ﺗﺤﻴﺔ ﻃﻴﺒﺔ ﻭﺑﻌﺪ‬

‫ﺃﺭﺟﻮ ﺍﻟﺘﻜﺮﻡ ﺑﻔﺤﺺ ﺍﻟﻄﺎﻟﺐ ﺍﻟﻤﺬﻛﻮﺭ ﺃﻋﻼﻩ ﻭﺇﻋﻼﻣﻨﺎ ﺑﺎﻟﻨﺘﻴﺠﺔ‬

‫‪..................................................................................................................‬‬ ‫ﺷﻜﻮﻯ ﺍﻟﻤﺮﻳﺾ‪:‬‬

‫‪..................................................................................................................‬‬

‫‪.....................................................‬‬ ‫‪ ......................................................‬ﺍﻟﺤﺮﺍﺭﺓ‪:‬‬ ‫ﺍﻟﻨﺒﺾ‪:‬‬

‫‪......................................................................................................................‬‬ ‫ﺍﻟﺘﺸﺨﻴﺺ‪:‬‬

‫‪.......................................................................................................................................‬‬

‫‪.......................................................................................................‬‬ ‫ﺗﻮﺻﻴﺎﺕ ﺍﻟﻄﺒﻴﺐ ﺍﻟﻤﻌﺎﻟﺞ ‪:‬‬

‫‪.......................................................................................................................................‬‬

‫ﺗﻮﻗﻴﻊ ﺍﻟﻄﺒﻴﺐ‬

‫‪.......................................‬‬ ‫‪20‬‬ ‫‪/ /‬‬ ‫ﺍﻟﺨﺘﻢ‬

‫ﻫﺬﺍ ﺍﻟﻨﻤﻮﺫﺝ ﺗﻢ ﻃﺒﺎﻋﺘﻪ ﺍﻟﻜﺘﺮﻭﻧﻴﺎ ﻣﻦ ﺧﻼﻝ ﺗﻄﺒﻴﻖ ﺳﻬﻞ‬

‫ﻳﺘﻢ ﺗﺴﻠﻴﻢ ﺍﻟﻨﻤﻮﺫﺝ ﻟﻠﻤﺪﺭﺳﺔ ﺑﻌﺪ ﺍﻋﺘﻤﺎﺩﻩ ﻣﻦ ﺍﻟﺠﻬﺔ ﺍﻟﺼﺤﻴﺔ ﺧﻼﻝ ﻳﻮﻣﻴﻦ ﻣﻦ ﺗﺎﺭﻳﺨﻪ‬