Certificat Medical
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Nr.
……. din …………… CERTIFICAT MEDICAL
In baza referatului Dr. ……………………………………………………………….. (numele si prenumele) in calitate de ……………………………… Se certifica : Dl. (Dna) ………………………………………………………………………….. in varsta de ….. ani, sex ….. , domiciliat in : localitatea ………………………jud……....…….. str. ……………………….. nr. …. cu C. I. seria ….. nr. ………. avand ocupatia de …………………………. Este suferind de : ………………………………………………………………………………. ………………………………………………………………………….……………………………. ………………………………………………………………….……………………………………. …………………………………………………………………….…………………………………. S-a eliberat prezentul spre a-i servi la …………………………………………………………
(semnatura si parafa)
……. din …………… CERTIFICAT MEDICAL
In baza referatului Dr. ……………………………………………………………….. (numele si prenumele) in calitate de ……………………………… Se certifica : Dl. (Dna) ………………………………………………………………………….. in varsta de ….. ani, sex ….. , domiciliat in : localitatea ………………………jud……....…….. str. ……………………….. nr. …. cu C. I. seria ….. nr. ………. avand ocupatia de …………………………. Este suferind de : ………………………………………………………………………………. ………………………………………………………………………….……………………………. ………………………………………………………………….……………………………………. …………………………………………………………………….…………………………………. S-a eliberat prezentul spre a-i servi la …………………………………………………………
(semnatura si parafa)
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