Certificat Prenuptial
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UNITATEA Bucuresti STR. Nr. din
NR.
CERTIFICAT MEDICAL
Subsemnatul Dr. __________________________________________________ medic
de
familie,
certific
prin
prezenta
ca
am
examinat
azi
pe
domnul (doamna) ___________________________________________________________ Din _______________ sector (judet) ____ str. _____________________ nr. ____ B.I. / C.I. seria ____ numar __________
Rezultat ex. pulmonar
________________________________________
Rezultat ex. neuro-psihic
________________________________________
Rezultat examen HIV
________________________________________
Am constatat ca (nu) este sanatos si (nu) sufera de vreo afectiune contagioasa, venerica sau neuro-psihica. Drept pentru care (nu) se elibereaza prezentul certificat spre a-i servi la ___________________________________________________________________________ Apt(a) / inapt(a) pentru _____________________
Medic
NR.
CERTIFICAT MEDICAL
Subsemnatul Dr. __________________________________________________ medic
de
familie,
certific
prin
prezenta
ca
am
examinat
azi
pe
domnul (doamna) ___________________________________________________________ Din _______________ sector (judet) ____ str. _____________________ nr. ____ B.I. / C.I. seria ____ numar __________
Rezultat ex. pulmonar
________________________________________
Rezultat ex. neuro-psihic
________________________________________
Rezultat examen HIV
________________________________________
Am constatat ca (nu) este sanatos si (nu) sufera de vreo afectiune contagioasa, venerica sau neuro-psihica. Drept pentru care (nu) se elibereaza prezentul certificat spre a-i servi la ___________________________________________________________________________ Apt(a) / inapt(a) pentru _____________________
Medic
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