‫ﺗﻘﺮﻳﺮ إﺟﺎزة ﻣﺮﺿﻴﺔ‬

Sick Leave
Report
GSL22011433312

MOH states that patient SHATHA ‫ﻳﻔﻴﺪ وزارة اﻟﺼﺤﺔ ﺑﺄن اﻟﻤﺮﻳﺾ ﺷﺬى ﻣﺤﻤﺪ ﻋﺒﺪه‬
MUHAMMED ABDU MIMESH Holder of ID 1113284093 ‫ﻣﻴﻤﺶ ﺻﺎﺣﺐ اﻟﻬﻮﻳﺔ رﻗﻢ‬
Number 1113284093 (tel:1113284093) ‫ ﻣﻦ‬7 ‫ ( ﻗﺪ ﻣﻨﺢ إﺟﺎزة ﻣﺮﺿﻴﺔ ل‬tel:1113284093
tel:1113284093))
has been given a sick leave report for 7 of - 1443 ‫ إﻟﻰ ﺗﺎرﻳﺦ‬07
07--06
06--1443 ‫اﻷﻳﺎم ﻣﻦ ﺗﺎرﻳﺦ‬
days from 2022-01-10 to 2022-01-16 : ‫ ﺣﺴﺐ اﻟﺘﺎﻟﻲ‬13
13--06

Patient’s Information ‫ﺑﻴﺎﻧﺎت اﻟﻤﺮﻳﺾ‬

Medical Record Number:
11132840930190019881901019 : ‫رﻗﻢ اﻟﺴﺠﻞ اﻟﻄﺒﻲ‬
11132840930190019881901019
1113284093 : ‫ اﻹﻗﺎﻣﺔ‬/ ‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ‬
National ID Number : 1113284093 (tel:1113284093)
(tel:1113284093)
Full Name : SHATHA MUHAMMED ABDU MIMESH ‫ ﺷﺬى ﻣﺤﻤﺪ ﻋﺒﺪه ﻣﻴﻤﺶ‬: ‫اﻻﺳﻢ اﻟﻜﺎﻣﻞ‬
Sick Leave Date : 2022-01-10 07-06-1443 : ‫ﺗﺎرﻳﺦ اﻻﺟﺎزة‬
Gender :Female ‫ أﻧﺜﻰ‬: ‫اﻟﺠﻨﺲ‬
Date of Birth : 2001-08-30 11-06-1422 : ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬
Nationality : Saudi Arabia ‫ اﻟﺴﻌﻮدﻳﺔ‬: ‫اﻟﺠﻨﺴﻴﺔ‬
Employer : - : ‫ﺟﻬﺔ اﻟﻌﻤﻞ‬
Occupation : - : ‫اﻟﻤﻬﻨﺔ‬
Visit Date :2022-01-10 07-06-1443 : ‫ﺗﺎرﻳﺦ اﻟﺪﺧﻮل‬
Discharge Date : 2022-01-10 07-06-1443 : ‫ﺗﺎرﻳﺦ اﻟﺨﺮوج‬
Revisit Date : ‫ ﺗﺎرﻳﺦ اﻟﻤﺮاﺟﻌﺔ‬:
Recommendation ‫اﻟﺘﻮﺻﻴﺎت‬
Sick Leave for 7 days ‫ أﻳﺎم‬7 ‫ﺗﻢ ﻣﻨﺤﻪ إﺟﺎزة ﻣﺮﺿﻴﺔ ﻟﻤﺪة‬
From :2022-01-10 07-06-1443 : ‫ﻣﻦ ﺗﺎرﻳﺦ‬
To : 2022-01-16 13-06-1443 : ‫ﺣﺘﻰ ﺗﺎرﻳﺦ‬
Consultation Date : : ‫ﻣﺮاﺟﻌﺔ اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ ﻗﺒﻞ اﻧﺘﻬﺎء إﺟﺎزﺗﻪ‬
Attending Physician Information ‫ﺑﻴﺎﻧﺎت اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ‬
Name : ABDULLAH MUFAREH ALI ASSIRI ‫ ﻋﺒﺪاﻟﻠﻪ ﻣﻔﺮح ﻋﻠﻲ ﻋﺴﻴﺮي‬: ‫اﻻﺳﻢ‬
Position : Consultant ‫ اﺳﺘﺸﺎري‬: ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬
Alternate Physician Information ‫ﺑﻴﺎﻧﺎت اﻟﻄﺒﻴﺐ اﻟﻤﻨﺎوب‬
Name : : ‫اﻻﺳﻢ‬
Position : : ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬
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