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‫ﺗ ﻘ ﺮﻳ ﺮ إ ﺟﺎ زة ﻣ ﺮ ﺿﻴ ﺔ‬

‫‪Sick Leave‬‬
‫‪Report‬‬
‫‪GGSL21072205643‬‬

‫‪MOH states that patient‬‬ ‫ﻳ ﻔﻴ ﺪ و زا ر ة اﻟ ﺼ ﺤ ﺔ ﺑﺄ ن اﻟ ﻤ ﺮﻳ ﺾ‬

‫‪Holder of ID number 1117273845‬‬ ‫ﺻﺎﺣﺐ اﻟﻬﻮﻳﺔ رﻗﻢ ‪1117273845‬‬

‫‪has been given a sick leave report for 10 of days‬‬ ‫ﻗﺪ ﻣﻨﺢ إﺟﺎزة ﻣﺮﺿﻴﺔ ل ‪ 10‬ﻣﻦ اﻷﻳﺎم‬

‫‪from 07/21/2021 00:00:00‬‬ ‫ﻣﻦ ﺗﺎرﻳﺦ ‪07/21/2021 00:00:00‬‬

‫‪to 07/30/2021 00:00:00‬‬ ‫إﻟﻰ ﺗﺎرﻳﺦ ‪07/30/2021 00:00:00‬‬

‫‪Patient’s Information‬‬ ‫ﺑﻴﺎﻧﺎ ت اﻟ ﻤ ﺮﻳ ﺾ‬

‫‪Medical record number:‬‬

‫رﻗﻢ اﻟﺴﺠﻞ اﻟﻄﺒﻲ‪11172738450190019881901019 :‬‬
‫‪11172738450190019881901019‬‬

‫‪National ID Number: 1117273845‬‬ ‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ ‪ /‬اﻹﻗﺎﻣﺔ ‪1117273845 :‬‬

‫‪Full Name: - - - -‬‬ ‫ا ﻻ ﺳ ﻢ اﻟ ﻜﺎ ﻣ ﻞ‪ :‬ﺗ ﺮ ﻛ ﻲ ﻋﺎ ﻃ ﻒ ﺑ ﻦ ﻓ ﻬ ﺪ اﻟ ﻘ ﺤ ﻄﺎﻧ ﻰ‬

‫‪Sick Leave Date: 07/21/2021 00:00:00‬‬ ‫ﺗﺎرﻳﺦ اﻹﺟﺎزة ‪07/21/2021 00:00:00 :‬‬

‫ذﻛﺮ ‪Gender:‬‬ ‫اﻟ ﺠﻨ ﺲ‪:‬ذ ﻛ ﺮ‬

‫‪Date of Birth: 1420-06-14‬‬ ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‪14-06-1420 :‬‬

‫‪Nationality:113‬‬ ‫اﻟﺠﻨﺴﻴﺔ‪113:‬‬

‫‪Employer:‬‬ ‫‪: -‬ﺟﻬﺔ اﻟﻌﻤﻞ‬

‫‪Occupation:‬‬ ‫‪: -‬اﻟﻤﻬﻨﺔ‬

‫‪Visit Date:: 07/21/2021 00:00:00‬‬ ‫ﺗﺎرﻳﺦ اﻟﺪﺧﻮل ‪07/21/2021 00:00:00 :‬‬

‫‪Discharge Date: 07/21/2021 00:00:00‬‬ ‫ﺗﺎرﻳﺦ اﻟﺨﺮوج ‪07/21/2021 00:00:00 :‬‬

‫‪Recommendation‬‬ ‫اﻟﺘ ﻮ ﺻﻴﺎ ت‬

‫‪Sick Leave for 10 days‬‬ ‫ﺗﻢ ﻣﻨﺤﻪ إﺟﺎزة ﻣﺮﺿﻴﺔ ﻟﻤﺪة ‪ 10‬أﻳﺎم‬

‫‪From: 07/21/2021 00:00:00‬‬ ‫ﻣﻦ ﺗﺎرﻳﺦ ‪07/21/2021 00:00:00 :‬‬

‫‪To: 07/30/2021 00:00:00‬‬ ‫ﺣﺘﻰ ﺗﺎرﻳﺦ ‪07/30/2021 00:00:00 :‬‬

‫ﻣﺮاﺟﻌﺔ اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ ﻗﺒﻞ اﻧﺘﻬﺎء ‪07/21/2021 00:00:00 :‬‬

‫‪Consultation Date: 07/21/2021 00:00:00‬‬
‫إ ﺟﺎ زﺗ ﻪ‬

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Attending Physician Information ‫ﺑﻴﺎﻧﺎ ت اﻟ ﻄﺒﻴ ﺐ اﻟ ﻤ ﻌﺎﻟ ﺞ‬

Name: ABDULLAH MUFAREH ALI ASSIRI ‫ ﻋ ﺒ ﺪا ﻟ ﻠ ﻪ ﻣ ﻔ ﺮ ح ﻋ ﻠ ﻲ ﻋ ﺴ ﻴ ﺮ ي‬: ‫ا ﻻ ﺳ ﻢ‬

Position: ‫ا ﺳ ﺘ ﺸ ﺎ ر ي‬: ‫ا ﻟ ﻤ ﺴ ﻤ ﻰ ا ﻟ ﻮ ﻇ ﻴ ﻔ ﻲ‬

Physician Information ‫ﺑﻴﺎﻧﺎ ت اﻟ ﻄﺒﻴ ﺐ اﻟ ﻤﻨﺎ و ب‬

Name: ‫ اﻻ ﺳﻢ‬:

Position: ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬:

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