‫‪363‬ﺩﺭﻫﻢ‬ ‫ﺩﻭﻟﺔ ﺍﻻﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ‬

‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻭﻭﻗﺎﻳﺔ ﺍﻟﻤﺠﺘﻤﻊ ‪ -‬ﺍﺩﺍﺭﺓ ﺍﻟﻄﺐ‬

‫ﺍﻟﻮﻗﺎﺋﻲ‬
‫ﻣﺮﻛﺰ ﻣﺮﺍﻗﺒﺔ ﺍﻻﻣﺮﺍﺽ‬

‫ﺍﻻﻳﺼﺎﻝ ‪0000190059087421‬‬

‫ﺷﻬﺎﺩﺓ ﺧﻠﻮ ﻣﻦ ﺍﻻﻣﺮﺍﺽ ﺍﻟﺘﻲ ﺗﺸﻜﻞ ﺧﻄﺮ ﻋﻠﻰ ﺍﻟﺼﺤﺔ‬

‫ﺍﻟﻌﺎﻣﺔ‬
‫ﺍﻟﻄﺒﻴﺔ‬ ‫ﺍﻟﺒﺮﺍﺣﺔ‬ ‫ﻣﻨﻄﻘﺔ‬

‫ﺩﺑﻲ‬ ‫ﺍﻟﻤﺮﻛﺰ ﺍﻟﻄﺒﻲ‬

‫ﺍﻟﺨﺎﺗﻢ ﺍﻟﺮﺳﻤﻲ‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬

‫ﺗﺠﺪﻳﺪ‬ ‫‪2019-07-08‬‬

‫ﺑﻴﺎﻧﺎﺕ ﺧﺎﺻﺔ ﺑﻄﺎﻟﺐ ﺍﻟﻔﺤﺺ‬

‫‪Arabic Name‬‬ ‫ﻛﻴﻨﻴﻨﻰ ﻧﻴﺠﻴﺴﻰ ﺩﻳﺒﻴﻠﻰ‬ ‫ﺍﻻﺳﻢ ﻋﺮﺑﻲ‬

‫‪English Name‬‬ ‫‪KENENI NEGESE DEBELE‬‬ ‫ﺍﻻﺳﻢ ﺍﻧﺠﻠﻴﺰﻱ‬

‫‪Gender‬‬ ‫ﺃﻧﺜﻰ‬ ‫ﺍﻟﺠﻨﺲ‬ ‫‪Age‬‬ ‫‪1991-11-15‬‬ ‫ﺍﻟﻌﻤﺮ‬

‫‪Nationality‬‬ ‫ﺇﺛﻴﻮﺑﻴﺎ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬

‫‪Entry Permit /‬‬ ‫‪101/2017/7/0105708‬‬ ‫ﺭﻗﻢ ﺍﺫﻥ ﺍﻟﺪﺧﻮﻝ‪/‬‬

‫‪Residence No‬‬ ‫ﺍﻻﻗﺎﻣﺔ‬

‫‪EIDA Applicatio‬‬ ‫‪784199163761911‬‬ ‫ﺭﻗﻢ‬ ‫‪Unified‬‬ ‫‪53953144‬‬ ‫ﺭﻗﻢ ﻣﻮﺣﺪ‬

‫‪No.‬‬ ‫ﺍﻟﻬﻮﻳﺔ‬ ‫‪No.‬‬
‫ﺃﻭ ﺍﻟﻄﻠﺐ‬
‫‪Profession‬‬ ‫ﺍﻟﻤﻬﻨﺔ‬
‫‪HOUSEMAID‬‬ ‫ﺧﺎﺩﻣﻪ‬

‫‪Sponsor Name‬‬ ‫ﻋﺒﺪ ﷲ ﻋﻠﻲ ﻋﺒﺪ ﺍﻟﺤﺒﻴﺐ ﻋﻤﺮ ﺍﻟﺠﺎﺑﺮﻱ‬ ‫ﺍﺳﻢ ﺍﻟﻜﻔﻴﻞ‬

‫‪Phone Number‬‬ ‫‪025456456‬‬ ‫ﻫﺎﺗﻒ ﺍﻟﻜﻔﻴﻞ‬

‫‪Sponsor Address‬‬ ‫ﺩﺑﻲ‬ ‫ﻋﻨﻮﺍﻥ ﺍﻟﻜﻔﻴﻞ‬

‫ﺧﺎﺹ ﻹﺳﺘﻌﻤﺎﻝ ﺇﺩﺍﺭﺓ ﺍﻟﻄﺐ ﺍﻟﻮﻗﺎﺋﻲ‬

‫‪2019-07-09‬‬ ‫ﺗﺎﺭﻳﺦ ﺇﺟﺮﺍﺀ ﺍﻟﻔﺤﺺ‬ ‫‪P040035D00887J‬‬ ‫ﺭﻗﻢ ﺍﻟﻄﺐ ﺍﻟﻮﻗﺎﺋﻲ‬

‫ﺍﻟﻄﺒﻲ‬
‫ﺇﺳﺘﻨﺎﺩ ًﺍ ﺇﻟﻰ ﺍﻟﻘﺎﻧﻮﻥ ﺍﻹﺗﺤﺎﺩﻱ ﺭﻗﻢ ‪ 27‬ﻟﺴﻨﺔ ‪ 1981‬ﻓﻲ ﺷﺄﻥ ﺍﻟﻮﻗﺎﻳﺔ ﻣﻦ ﺍﻷﻣﺮﺍﺽ‬
‫ﺍﻟﺴﺎﺭﻳﺔ ‪ ،‬ﻓﻘﺪ ﺗﻢ ﺇﺟﺮﺍﺀ ﺍﻟﻔﺤﺺ ﺍﻟﻄﺒﻲ ﺍﻟﻼﺯﻡ ﻟﻠﻤﺬﻛﻮﺭ ﺃﻋﻼﻩ ﻭﻛﺎﻧﺖ ﺍﻟﻨﺘﻴﺠﺔ‬

‫ﻻﺋﻖ ﻃﺒﻴ ﺎ ً‬

‫ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﻜﺘﺮﻭﻧﻴﺔ ﺍﻟﺘﺤﻘﻖ ﻣﻦ ﺻﺤﺔ ﺍﻟﺸﻬﺎﺩﺓ ﻣﻦ ﺧﻼﻝ ﺍﻟﻤﻮﻗﻊ‬

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‫ﻣﻼﺣﻈﺔ ‪ :‬ﺻﻼﺣﻴﺔ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﺛﻼﺛﺔ )‪ (3‬ﺃﺷﻬﺮ ﻣﻦ ﺗﺎﺭﻳﺦ ﺇﺟﺮﺍﺀ ﺍﻟﻔﺤﺺ ﺍﻟﻄﺒﻲ‬