Translated from romanian

CERTIFICATE OF MEDICAL LEAVE

Primary : continuation of certificate No-

Series- 01 No. 2143355

Name and address of the curative institution : IMSR CMUAP ,31 August ,137A.
Stamp: Health Ministry of the Republic of Moldova. Public Medical Sanitary Institution. Clinical
Hospital of the Health Ministry. Consultative Diagnostic Centre. For certificates of medical leave.
Issued on : July 26.2016
Patient name , Surname : POLOZEAN ARTUR, 25 years old, sex: M.
Place of work enterprise or institution name- AL TAYER.
Diagnosis--Final diagnosis --The cause of vitality delimitation --Regime : outpatient
Information about the break of order
Physician signature /--/
He was hospitalized since : ---

Realeased from the work :

Since the date

Up to the date

Doctor signature

26.07.2016

the twenty eighth of July

/signature/ Vatamaniuc

29.07.2016

the thirty-first of July

/ signature/ Vatamaniuc

01.08.2016

the seventh of august

/signature / Vatamaniuc

He will begin the work on :

The eighth of august.
Function name and signature of doctor

/signature/ Vatamaniuc

Stamp: Health Ministry of the Republic of Moldova. Public Medical Sanitary Institution. Clinical
Hospital of the Health Ministry. Consultative Diagnostic Centre. For certificates of medical leave.