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  • 08 F Scrisoare Medicala

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    cora4eva5699
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    Scrisoare Medicala

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    08 f Scrisoare Medicala

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    Scrisoare Medicala

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    08 F Scrisoare Medicala

    Diunggah oleh

    cora4eva5699
    Scrisoare Medicala

    Hak Cipta:

    © All Rights Reserved
    Unduh sebagai DOC, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 1

    ANEXA Nr.

    5
    la metodologie

    Nr. ................/................

    SCRISOARE MEDICALĂ

    Numele .................................................. prenumele ............................................,


    CNP ......................................................., vârsta ...................................................
    1. Anamneză
    - antecedente personale patologice
    . .......................................................................................................................................
    . .......................................................................................................................................
    . ........................................................................................................................................

    2. Diagnosticul medical
    - principal .........................................................................................................................
    . ........................................................................................................................................
    - altele ...............................................................................................................................
    . .........................................................................................................................................
    . ..........................................................................................................................................
    . ..........................................................................................................................................

    3. Certificatele medicale actuale (se specifică numărul, data, instituţia emitentă şi numele
    medicului care a eliberat certificatul)
    . ........................................................................................................................................
    . ........................................................................................................................................
    . .........................................................................................................................................
    . ........................................................................................................................................

    4. Internări în spital (data, instituţia emitentă şi diagnosticul la ieşirea din spital)


    . ...........................................................................................................................................
    . ............................................................................................................................................
    . ............................................................................................................................................

    5. Persoana - este deplasabilă;


    - nu este deplasabilă.

    Data completării ...........................

    Semnătura şi parafa medicului de familie


    ............................................

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