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‫ﺗ ﻘ ﺮﻳ ﺮ إ ﺟﺎ زة ﻣ ﺮ ﺿﻴ ﺔ‬

Sick Leave
Report
GGSL21102002925

badr primery health center states that patient ‫ﻳ ﻔﻴ ﺪ ﻣ ﺮ ﻛ ﺰ ﺻ ﺤ ﻲ ﺑ ﺪ ر ﺑﺄ ن اﻟ ﻤ ﺮﻳ ﺾ‬

Holder of ID number 1111096424 1111096424 ‫ﺻﺎﺣﺐ اﻟﻬﻮﻳﺔ رﻗﻢ‬

has been given a sick leave report for 1 of days ‫ ﻣ ﻦ ا ﻷﻳﺎ م‬1 ‫ﻗ ﺪ ﻣﻨ ﺢ إ ﺟﺎ ز ة ﻣ ﺮ ﺿﻴ ﺔ ل‬

from 10/20/2021 00:00:00 10/20/2021 00:00:00 ‫ﻣﻦ ﺗﺎرﻳﺦ‬

to 10/20/2021 00:00:00 10/20/2021 00:00:00 ‫إﻟﻰ ﺗﺎرﻳﺦ‬

Patient’s Information ‫ﺑﻴﺎﻧﺎ ت اﻟ ﻤ ﺮﻳ ﺾ‬

Medical record number: 1 1 :‫ر ﻗ ﻢ اﻟ ﺴ ﺠ ﻞ اﻟ ﻄﺒ ﻲ‬

National ID Number: 1111096424 1111096424 : ‫ اﻹﻗﺎﻣﺔ‬/ ‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ‬

Full Name: YOUSEF OTHMAN ABDULLAH ALSUBHI ‫ ﻳ ﻮ ﺳ ﻒ ﻋ ﺜ ﻤ ﺎ ن ﻋ ﺒ ﺪا ﻟ ﻠ ﻪ ا ﻟ ﺼ ﺒ ﺤ ﻰ‬: ‫ا ﻻ ﺳ ﻢ ا ﻟ ﻜ ﺎ ﻣ ﻞ‬

Sick Leave Date: 10/20/2021 13:10:09 10/20/2021 13:10:09 : ‫ﺗﺎرﻳﺦ اﻹﺟﺎزة‬

Gender: ‫ذﻛﺮ‬ ‫ذ ﻛ ﺮ‬:‫اﻟ ﺠﻨ ﺲ‬

Date of Birth: 03-01-1422 1422-01-03 :‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬

Nationality:113 113:‫اﻟﺠﻨﺴﻴﺔ‬

Employer: ‫ﺟﻬﺔ اﻟﻌﻤﻞ‬:

Occupation: ‫اﻟﻤﻬﻨﺔ‬:

Visit Date:: 10/20/2021 00:00:00 10/20/2021 00:00:00 : ‫ﺗﺎرﻳﺦ اﻟﺪﺧﻮل‬

Discharge Date: 10/20/2021 00:00:00 10/20/2021 00:00:00 : ‫ﺗﺎرﻳﺦ اﻟﺨﺮوج‬

Recommendation ‫اﻟﺘ ﻮ ﺻﻴﺎ ت‬

Sick Leave for 1 days ‫ أﻳﺎ م‬1 ‫ﺗ ﻢ ﻣﻨ ﺤ ﻪ إ ﺟﺎ ز ة ﻣ ﺮ ﺿﻴ ﺔ ﻟ ﻤ ﺪ ة‬

From: 10/20/2021 00:00:00 10/20/2021 00:00:00 : ‫ﻣﻦ ﺗﺎرﻳﺦ‬

To: 10/20/2021 00:00:00 10/20/2021 00:00:00 : ‫ﺣﺘﻰ ﺗﺎرﻳﺦ‬

10/20/2021 13:10:09 : ‫ﻣﺮاﺟﻌﺔ اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ ﻗﺒﻞ اﻧﺘﻬﺎء‬

Consultation Date: 10/20/2021 13:10:09
‫إ ﺟﺎ زﺗ ﻪ‬

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

Name: KHALID AHMED MOHAMMED AHMED ‫ ﺧﺎﻟﺪ ا ﺣ ﻤﺪ ﻣ ﺤ ﻤﺪ ا ﺣ ﻤﺪ‬:‫ا ﻻ ﺳ ﻢ‬

Position: ‫ ﻃﺒﻴ ﺐ ﻋﺎ م‬:‫اﻟ ﻤ ﺴ ﻤ ﻰ اﻟ ﻮ ﻇﻴ ﻔ ﻲ‬

Physician Information ‫ﺑﻴﺎﻧﺎ ت اﻟ ﻄﺒﻴ ﺐ اﻟ ﻤﻨﺎ و ب‬

Name: ‫ اﻻ ﺳﻢ‬:

Position: ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬:

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