‫‪10.

55‬‬ ‫ﺍﻟﻮﻗﺖ‪:‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺘﺮﺑﻴﺔ‬

‫‪2023/04/26‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ ‪:‬‬ ‫ﺍﻹﺩﺍﺭﺓ ﺍﻟﻌﺎﻣﺔ ﻟﻤﻨﻄﻘﺔ ﺍﻷﺣﻤﺪﻱ ﺍﻟﺘﻌﻠﻴﻤﻴﺔ‬
‫ﺍﻧﻴﺴﺔ ﺑﻨﺖ ﺧﺒﻴﺐ ﺍﻻﻧﺼﺎﺭﻳﺔ ﺍﻟﺜﺎﻧﻮﻳﺔ ﻟﻠﺒﻨﺎﺕ ‪ -‬ﺍﻟﻤﺸﺘﺮﻛﺔ‬

‫ﺗﺤﻮﻳﻞ ﻃﺒـﻲ‬
‫ﻣﻠﻜﻪ ﺷﺮﻳﻒ ﻋﺒﺪﺍﻟﻔﺘﺎﺡ ﻋﻠﻰ‬ ‫ﺍﺳﻢ ﺍﻟﻄﺎﻟﺐ ‪:‬‬

‫‪305110501807‬‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﻤﺪﻧﻲ ‪:‬‬

‫‪1‬‬ ‫‪/‬‬ ‫ﺍﻟﺼﻒ ﺍﻟﺤﺎﺩﻱ ﻋﺸﺮ ‪ -‬ﺍﺩﺑﻲ‬ ‫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