‫ﺗﻘﺮﻳﺮ إﺟﺎزة ﻣﺮﺿﻴﺔ‬

Sick Leave
Report
GSL19102301719

king abdullah medical complex jeddah ‫ﻳﻔﻴﺪ ﻣﺠﻤﻊ اﻟﻤﻠﻚ ﻋﺒﺪاﻟﻠﻪ اﻟﻄﺒﻲ ﺑﺠﺪة ﺑﺄن‬
states that patient HISSAH AHMED ALI ‫اﻟﻤﺮﻳﺾ ﺣﺼﻪ اﺣﻤﺪ ﻋﻠﻲ اﻟﻐﺎﻣﺪي ﺻﺎﺣﺐ اﻟﻬﻮﻳﺔ‬
ALGHAMDI Holder of ID Number ‫ ( ﻗﺪ‬tel:1005982234
tel:1005982234)) 1005982234 ‫رﻗﻢ‬
1005982234 (tel:1005982234) has been - 1441 ‫ ﻣﻦ اﻷﻳﺎم ﻣﻦ ﺗﺎرﻳﺦ‬17 ‫ﻣﻨﺢ إﺟﺎزة ﻣﺮﺿﻴﺔ ل‬
given a sick leave report for 17 of days from : ‫ ﺣﺴﺐ اﻟﺘﺎﻟﻲ‬03
03--03
03--1441 ‫ إﻟﻰ ﺗﺎرﻳﺦ‬16
16--02
2019-10-15 to 2019-10-31

Patient’s Information ‫ﺑﻴﺎﻧﺎت اﻟﻤﺮﻳﺾ‬

Medical Record Number: 307987 307987 : ‫رﻗﻢ اﻟﺴﺠﻞ اﻟﻄﺒﻲ‬
1005982234 : ‫ اﻹﻗﺎﻣﺔ‬/ ‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ‬
National ID Number : 1005982234 (tel:1005982234)
(tel:1005982234)
Full Name : HISSAH AHMED ALI ALGHAMDI ‫ ﺣﺼﻪ اﺣﻤﺪ ﻋﻠﻲ اﻟﻐﺎﻣﺪي‬: ‫اﻻﺳﻢ اﻟﻜﺎﻣﻞ‬
Sick Leave Date : 2019-10-23 24-02-1441 : ‫ﺗﺎرﻳﺦ اﻻﺟﺎزة‬
Gender :Female ‫ أﻧﺜﻰ‬: ‫اﻟﺠﻨﺲ‬
Date of Birth : 1984-04-02 01-07-1404 : ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬
Nationality : Saudi Arabia ‫ اﻟﺴﻌﻮدﻳﺔ‬: ‫اﻟﺠﻨﺴﻴﺔ‬
Visit Date :2019-10-15 16-02-1441 : ‫ﺗﺎرﻳﺦ اﻟﺪﺧﻮل‬
Discharge Date : 2019-10-15 16-02-1441 : ‫ﺗﺎرﻳﺦ اﻟﺨﺮوج‬
Revisit Date : ‫ ﺗﺎرﻳﺦ اﻟﻤﺮاﺟﻌﺔ‬:
Recommendation ‫اﻟﺘﻮﺻﻴﺎت‬
Sick Leave for 17 days ‫ أﻳﺎم‬17 ‫ﺗﻢ ﻣﻨﺤﻪ إﺟﺎزة ﻣﺮﺿﻴﺔ ﻟﻤﺪة‬
From :2019-10-15 16-02-1441 : ‫ﻣﻦ ﺗﺎرﻳﺦ‬
To : 2019-10-31 03-03-1441 : ‫ﺣﺘﻰ ﺗﺎرﻳﺦ‬
Consultation Date : : ‫ﻣﺮاﺟﻌﺔ اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ ﻗﺒﻞ اﻧﺘﻬﺎء إﺟﺎزﺗﻪ‬
Attending Physician Information ‫ﺑﻴﺎﻧﺎت اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ‬
Name : BANDER ALI J ALJAHDALI ‫ ﺑﻨﺪر ﻋﻠﻲ ﺟﻤﻌﻪ اﻟﺠﺤﺪﻟﻲ‬: ‫اﻻﺳﻢ‬
Position : Consultant ‫ ﻃﺒﻴﺐ اﺳﺘﺸﺎري‬: ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬
Alternate Physician Information ‫ﺑﻴﺎﻧﺎت اﻟﻄﺒﻴﺐ اﻟﻤﻨﺎوب‬
Name : : ‫اﻻﺳﻢ‬
Position : : ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬