νΎϳέϟ΍ΓΎγ΍ϭϣϟ΍ϰϔηΗγϣ

ΔϳοέϣΓίΎΟΈΑέϳέϘΗ
SICK LEAVE REPORT

Patient Name : VENU GOPAL - GONUGUNTLA ϼΗϧϭϏϭϧϭΟϝΎΑϭϏϭϧϳϓ : νϳέϣϟ΍ϡγ΍

File Number : 326767 326767 : ϲΑρϟ΍ϝΟγϟ΍ϡϗέ
Nat.ID/Iqama No : 2478829167 2478829167 : ΔϣΎϗϹ΍ϲϧΩϣϟ΍ϝΟγϟ΍ϡϗέ
Gender : MALE έϛΫ : αϧΟϟ΍
Nationality : INDIAN INDIAN : ΔϳγϧΟϟ΍
Occupation : : ΔϧϬϣϟ΍
Place of Work : Other ϯέΧ΃ : ϝϣόϟ΍ΔϬΟ
Date of Visit : 20-02-2024 ˰˰ϫ1445-08-10 : ΔόΟ΍έϣϟ΍ΦϳέΎΗ
Admission Date : 20-02-2024 ˰˰ϫ1445-08-10 : ϝϭΧΩϟ΍ΦϳέΎΗ
Discharge Date : 20-02-2024 ˰˰ϫ1445-08-10 : ΝϭέΧϟ΍ΦϳέΎΗ

Recommendation ΕΎ˰˰˰˰˰˰˰˰˰˰ϳλϭ˰˰˰˰˰˰˰˰˰˰Ηϟ΍
Following medical examination , it is recommended ϲΗϻ΍ϲλϮϧξϳήϤϟ΍ϰϠϋϒθϜϟΎΑ :
Sick Leave for 1 Day(s) ϡΎϳ΃ϡϮϳ 1 : ΔΑΎΘϛΓΪϤϟΔϴοήϣΓίΎΟ·ϪΤϨϣ
Starting From 21-02-2024 to 21-02-2024 ˰˰ϫ 11-08-1445 ϲϟ·˰˰ϫ 11-08-1445 Ϧϣ˱΍έΎΒΘϋ΍ϡΎϳ΃
Follow up before end of sick leave. ϪΗίΎΟ·˯ΎϬΘϧ΍ϞΒϗΞϟΎόϤϟ΍ΐϴΒτϟ΍ΔόΟ΍ήϣ
Referral to medical Committee for following . ΔϴϟΎΘϟ΍ΏΎΒγϷ΍ΪΣϻΔϴΒτϟ΍ΔΌϴϬϟ΍ϰϟ·ϪΘϟΎΣ·
Reasons : : ΏΎ˰˰γϷ΍
Approval of sick Leave. ϲΒτϟ΍ήϳήϘΘϟ΍ΩΎϤΘϋ·
Cannot be treated at this facility. ϰϔθΘδϤϟ΍ϲϓϪΟϼϋϦϜϤϤϟ΍ήϴϏϦϣ
Permanent of partial disability. Δϴότϗϭ΍Δϴ΋ΰΟΓέϮμΑϞϤόϟ΍ϦϋϲΤμϟ΍ϩΰΠϋϰϠϋϝΪΗϪΘϟΎΣ
Others ϯήΧ΃

Badge No : R3198 R3198 : ϡϗέϟ΍

Atten.Physician : Dr. AZZA MOHAMMED METWALY ϲϟϭΗϣΩϣΣϣΓίϋ .ΩΐϴΒτϟ΍Ϣγ΍

Create By Badge No : R3198 R3198 : ˯Ύηϧ·Ϣϗήϟ΍

Creating Physician : Dr. AZZA MOHAMMED METWALY ϲϟϭΗϣΩϣΣϣΓίϋ .Ω ˯Ύηϧ· ΐϴΒτϟ΍Ϣγ΍

Approved by the Director : Dr. Waleed Ahmad Altaib ϢγΎϗΐϴτϟ΍ΪϤΣ΃ΪϴϟϭέϮΘϛΩ : (ϢγϹ΍ ήϳΪϤϟ΍ϖϳΪμΗ
Qasem
Date : 20-02-2024 ˰˰ϫ1445-08-10 : ΦϳέΎΘϟ΍
This form is electronically signed ΎϳϧϭέΗϛϟ΍ϊϗϭϣΝΫϭϣϧϟ΍΍Ϋϫ

/ ΓΩΎόγ

ϩϼϋ΍Ϫϣγ΍΢οϭϣϟ΍ϰϠϋϲΑρϟ΍ϑηϛϟ΍ΏϠρϥ΄ηΑ˰ϫΦϳέΎΗΑ  ϡϗέϡϛΗϟΎΣ΃ϰϟ·ΓέΎη·

Ϫϧ΄ηΑέΩΎλϟ΍έϳέϘΗϟ΍ϪϳϟΎόΑϥϭΩΟΗϪϳϠϋϑηϛϠϟϩϼϋ·Ϫϣγ΍΢οϭϣϟ΍ϡϛϳΩϟϑυϭϣϟ΍ΔόΟ΍έϣϰϟ·ΓέΎη·
ϱέ΍ΩϹ΍ήϳΪϤϟ΍ήϳΪϤϟ΍
ϡ˰˰˰˰˰˰˰˰˰Η˰˰˰˰˰˰Χϟ΍
: ΃ϪϤγ΍
: ΦϳέΎΘϟ΍

OP24020186808 R3198 : Printed By