Medical Certificate

Forest Lakes Medical Centre, Date: 26/05/2023

Building B/36 Murdoch Rd, Phone: (08) 9493 3146
Thornlie WA 6108 Email: F.L.MEDICAL@gmail.com

I (Name) _________________________________________________M.B.B.S
DR YUSTILOA LEE YHIANG Doctor in __________
PHYSICAL/MENTAL HEALTH
___________________________ after careful Personal examination of the ease hereby Certify that
DYLAN SHANE JENKINS
_______________________________________ Whose signature is given above is suffering from

__________________________________________________________________________________
RIGHT LOWER LEG PAIN CAUSED BY=FRACTURE ON SHIN BONE (MENTALLY UNSTABLE)

And that is consider that a period of absence duty of _______________________________________

ANY FORM OF EMPLOYMENT/STUDY

With effect from ____________________________________________________________________

26TH OF MAY 2023 UNTIL 17TH OF NOVEMBER 2023

Is absolutely necessary for the restoration of his / her health.

Date ______________________________________________________

Place _______________________________________________________

Signature of Medical Officer _____________________________________

SIGNATURE:
_________________
Registration No ________________________________________________

Part of Registration ______________________________________________

System of Medicine _______________________________________________