‫ﺗ ﻘ ﺮ ﻳ ﺮ إ ﺟﺎز ة ﻣ ﺮ ﺿ ﻴ ﺔ‬

‫‪Sick Leave Report‬‬

‫‪GSL22053001861‬‬

‫‪Alnoor Specialist Hospital states that patient MOHAMMAD‬‬

‫ﻳ ﻔ ﻴــ ﺪ ﻣ ﺴ ﺘ ﺸــ ﻔ ﻰ ا ﻟ ﻨـ ﻮ ر ا ﻟ ﺘ ﺨ ﺼ ﺼـ ﻲ ﺑــــــ ﺄ ن ا ﻟ ﻤ ﺮ ﻳ ﺾ ﻣ ﺤ ﻤــ ﺪ ا ﺑـ ﻦ ﻣ ﻌ ﺘــ ﻮ ق ا ﺑ ﻦ‬
‫‪MATOUQ S JAWA Holder of ID Number 1015905258 has been‬‬
‫ﺳﻠﻴﻤﺎن ﺟﺎوه ﺻﺎﺣﺐ اﻟﻬﻮﻳﺔ رﻗﻢ ‪ 1015905258‬ﻗﺪ ﻣﻨﺢ إﺟﺎزة ﻣﺮﺿﻴﺔ ل ‪1‬‬
‫‪given a sick leave for 1 of days from 2022-05-30 to 2022-05-‬‬
‫ﻣﻦ اﻷﻳﺎم ﻣﻦ ﺗﺎرﻳﺦ ‪ 29-10-1443‬إﻟﻰ ﺗﺎرﻳﺦ ‪ 29-10-1443‬ﺣﺴﺐ اﻟﺘﺎﻟﻲ‪:‬‬
‫‪30.‬‬

‫‪Patient’s Information‬‬ ‫ﺑ ﻴﺎ ﻧﺎ ت ا ﻟ ﻤ ﺮ ﻳ ﺾ‬

‫‪Medical Record Number: 547453‬‬ ‫رﻗﻢ اﻟﺴﺠﻞ اﻟﻄﺒﻲ ‪547453 :‬‬

‫‪National ID Number : 1015905258‬‬ ‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ ‪ /‬اﻹﻗﺎﻣﺔ ‪1015905258 :‬‬

‫‪Full Name : MOHAMMAD MATOUQ S JAWA‬‬ ‫ا ﻻ ﺳ ﻢ اﻟ ﻜﺎ ﻣ ﻞ ‪ :‬ﻣ ﺤ ﻤ ﺪ اﺑ ﻦ ﻣ ﻌ ﺘ ﻮ ق اﺑ ﻦ ﺳ ﻠ ﻴ ﻤﺎ ن ﺟﺎ و ه‬

‫‪Sick Leave Issue Date : 2022-05-30‬‬ ‫ﺗﺎرﻳﺦ إﺻﺪار اﻹﺟﺎزة اﻟﻤﺮﺿﻴﺔ ‪29-10-1443 :‬‬

‫‪Gender :Male‬‬ ‫اﻟ ﺠﻨ ﺲ ‪ :‬ذ ﻛ ﺮ‬

‫‪Date of Birth : 1980-12-25‬‬ ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد ‪18-02-1401 :‬‬

‫‪Nationality : Saudi Arabia‬‬ ‫اﻟ ﺠ ﻨ ﺴ ﻴ ﺔ ‪ :‬اﻟ ﺴ ﻌ ﻮ دﻳ ﺔ‬

‫‪Employer :‬‬ ‫ﺟ ﻬ ﺔ اﻟ ﻌ ﻤ ﻞ ‪:‬‬

‫‪Occupation :‬‬ ‫اﻟ ﻤ ﻬﻨ ﺔ ‪:‬‬

‫‪Visit Date : 2022-05-30‬‬ ‫ﺗﺎرﻳﺦ اﻟﺪﺧﻮل ‪29-10-1443 :‬‬

‫‪Discharge Date : 2022-05-30‬‬ ‫ﺗﺎرﻳﺦ اﻟﺨﺮوج ‪29-10-1443 :‬‬

‫‪Revisit Date :‬‬ ‫ﺗﺎرﻳ ﺦ ا ﻟ ﻤ ﺮ ا ﺟ ﻌ ﺔ ‪:‬‬

‫‪Recommendation‬‬ ‫ا ﻟ ﺘ ﻮ ﺻ ﻴﺎ ت‬

‫‪Sick Leave for 1 days‬‬ ‫ﺗ ﻢ ﻣ ﻨ ﺤ ﻪ إ ﺟﺎز ة ﻣ ﺮ ﺿ ﻴ ﺔ ﻟ ﻤ ﺪ ة ‪ 1‬أﻳﺎ م‬

‫‪From : 2022-05-30‬‬ ‫ﻣﻦ ﺗﺎرﻳﺦ ‪29-10-1443 :‬‬

‫‪To : 2022-05-30‬‬ ‫ﺣﺘﻰ ﺗﺎرﻳﺦ ‪29-10-1443 :‬‬

‫‪Consultation Date :‬‬ ‫ﻣ ﺮ ا ﺟ ﻌ ﺔ ا ﻟ ﻄ ﺒ ﻴ ﺐ ا ﻟ ﻤ ﻌﺎ ﻟ ﺞ ﻗ ﺒ ﻞ اﻧ ﺘ ﻬﺎ ء إ ﺟﺎزﺗ ﻪ ‪:‬‬

‫‪Attending Physician Information‬‬ ‫ﺑ ﻴﺎ ﻧﺎ ت ا ﻟ ﻄﺒ ﻴ ﺐ ا ﻟ ﻤ ﻌﺎ ﻟ ﺞ‬

‫‪Name : WISAM AHMED A SIAM‬‬ ‫ا ﻻ ﺳ ﻢ ‪ :‬و ﺳﺎ م ا ﺣ ﻤ ﺪ ﻋ ﺒ ﺪ ﷲ ﺳ ﻴﺎ م‬

‫‪Position : General Practitioner‬‬ ‫اﻟ ﻤ ﺴ ﻤ ﻰ اﻟ ﻮ ﻇ ﻴ ﻔ ﻲ ‪ :‬ﻃ ﺒ ﻴ ﺐ ﻋﺎ م‬

‫‪Alternate Physician Information‬‬ ‫ﺑ ﻴﺎ ﻧﺎ ت ا ﻟ ﻄﺒ ﻴ ﺐ ا ﻟ ﻤﻨﺎ و ب‬

‫‪Name :‬‬ ‫اﻻﺳﻢ ‪:‬‬

‫‪Position :‬‬ ‫اﻟ ﻤ ﺴ ﻤ ﻰ اﻟ ﻮ ﻇ ﻴ ﻔ ﻲ ‪:‬‬

‫ﻟ ﻠ ﺘ ﺤ ﻘ ﻖ ﻣ ﻦ ﺻ ﺤ ﺔ ا ﻟ ﺘ ﻘ ﺮﻳ ﺮ ﻳ ﺮ ﺟ ﻰ زﻳﺎر ة ﻣ ﻨ ﺼ ﺔ ﺻ ﺤ ﺔ ﻋ ﻠ ﻰ‬
‫اﻟ ﺮاﺑ ﻂ‬
‫‪https://www.seha.sa/Home/SickLeave‬‬
‫و إ د ﺧﺎ ل اﻟ ﺮ ﻗ ﻢ اﻟ ﻤ ﺮ ﺟ ﻌ ﻲ ﻟ ﻠ ﺘ ﻘ ﺮﻳ ﺮ‬