kingdom of Saudi Arabia

ministry of health
directorate of health affairs Jeddah
althager hospital ,Jeddah
/ /

‫اﺟﺎزة ﻣﺮﺿﯿﺔ‬

Medical record no: 1116911999

1127204327

f ‫ذكر‬
m fm‫انثى‬ Patient name ‫الجحدلي‬ ‫حضرم‬
‫العتﯿبي‬ ‫هاجر مساعد‬
‫فﺮاس سعد‬

Data of birth: 2002/15/17

2004/11/28 : Nationality: ‫سعوديه‬
‫سعﻮدي‬

place of work: Occupation:

Clinic / ward: data of visit :

discharge data : 2022/06/12

2021 / 10 / 20 : Adm. Date: 2022/06/12
2021 / 10 / 10
20 :

Recommendations: : ‫اﻟﺘﻮﺻﯿﺎت‬
To examine the patient, we recommend the following: : ‫ﺑﺎﻟﻜﺸﻒ ﻋﻠﻲ اﻟﻤﺮﯾﺾ ﻧﻮﺻﻲ ﺑﺎﻷﺗﻲ‬

Giving him sick leave for one day ‫ﻟﻤﺪ)ة( يوم‬

( )‫يومان‬ ‫ﻣﺮﺿﯿﺔﻟﻤﺪة‬
‫زةزةﻣﺮﺿﯿﺔ‬
‫ﺟﺎﺟﺎ‬
‫ﻣﻨﺤﮫ ا‬
‫ﻣﻨﺤﮫ ا‬ ✓
20-10-2021 ‫ إﻟﻲ‬2022/06/12
2022/06/13 20-10-2021 ‫إﻋﺘﺒﺎرا ﻣﻦ ﺗﺎريﺦ‬
08/01/2022
Refer to the attending physician before the expiry of his leave ‫ﻣﺮاﺟعﮫ اﻟطﺒﯿﺐ اﻟﻤعﺎﻟﺞ ﻗﺒﻞ إﻧﺘﮭﺎء اﺟﺎزﺗﮫ‬
Referral General Medical Authority the following reasons: ‫إﺣﺎﻟﺘﮫ اﻟﻲ اﻟﮭﯿﺌﺔ اﻟﻄﺒﯿﺔ اﻟعﺎﻣﺔ ﻷﺣﺪ اﻷﺳﺒﺎب اﻷﺗﯿﺔ‬
Approval of the medical report ‫اﻋﺘﻤﺎد اﻟﺘﻘﺮيﺮ اﻟﻄﺒﻲ‬
It cannot be treated in hospital ‫ﻣﻦ ﻏﯿﺮ اﻟﻤﻤﻜﻦ ﻋﻼﺟﮫ ﺑﺎﻟﻤﺴﺘﺸﻔﻲ‬
His condition indicates that he is partially ‫ﺣﺎﻟﺘﮫ ﺗﺪل ﻋﻠﻲ ﻋﺠﺰه اﻟﺼﺤﻲ ﻋﻦ اﻟعﻤﻞ ﺑﺼورة ﺟﺰﺋﯿﺔ او ﻗﻄعﯿﺔ‬
or completely unable to work ‫اﻟﺘﮭﺎب ﺣﺎد ﺑﺎﻟﻘوﻟون اﻟﮭﺎﺑط‬ ✓
Other