Judetul ________________________ Nr. fisa/carnet de sanatate Localitatea ______________________ Unitatea sanitara _________________ _______________________
ADEVERINTA MEDICALA
Se adevereste ca: __________________________________________ in varsta de ____ ani, (numele si prenumele) cu domiciliul in: judetul _____________________ localitatea _______________________ str._______________________________________________________ nr _____________ avand ocupatia de:____________________________ in ___________________________ Este suferind de: ___________________________________________________________ Se recomanda _____________________________________________________________ S-a eliberat prezenta spre a-i servi la : __________________________________________
Semnatura si parafa medicului.
Data eliberarii:
_________ luna ___________ ziua ______ LS _________________________
cea mai buna parerea mea ? – poza de roland, in Tutoriale hacking · 36.6KB
