J200 Bratislava Worlg

Tennis
ITF World Tennis Tour ON-SITE TOur
Juniors
MEDICAL CERTIFICATE
Week of City,Country Grade Tourn, Key ITF Supervisor
10JAN 2024 Bratislava, SVK J-J200-SVK-01A-2024 Jarmila Kovacova
Famlly name First name Nationality Date of birth IPIN
KOLYADA Anastasiya UKR 17 Jun 2007 KOL1491630
Singles Doubles
11 Jan 2024 Retired MD 11 Jan 2024 stillin the draw MD
This On-Site Medical is VALID FOR APPEAL of the late withdrawal penalty IF completed and signed bythe physician, for this and
following tournament(s) until the stated expiry date or until the player next competes in competitive tennis (whichever occurs
|first). Please note tourn. key, week and place you wish to use this medical for appeal.
Tournament Name Date |Cty Country Prize Money

I, the undersigned examining Physician, certify that Ihave personally conducted aphysical examination of the above named tennis player and my
full medical report thereof is as follows. Inthe event that the ITF requires the player to be examined by an independant physician, I agree to
Consult with such physican with respect to my examination and diagnosis.
Place of examination Date of examination Time of examinaion National 1D number
On eovrt
HISTORY OF INJURY OR ILLNESS
)-0244PM
| Date of onset
Dñri ng Hhe match plyer sprened ho 1.).2024
Rkk -suaichous o broken Sta metuthr sol-Sengt to mesly boory
DIAGNOSIS
Spvained ledt cankle
SUGGESTED INITIAL TREATMENT

Pgst lel, imabilized by cost

INSTRUCTIONS FOR FURTHER EXAMINATION OR FOLLOW-UP

|As a result of my examination it is my medical judgment that the above named player:
issuffering fromthe injury or illness diagnosed above and as a result thereof should not participate
in competitive tennis from:
to:.lo 2004
is fit toplay competitive tennis
SIGNATURE OF PHYSICIAN
Printed name of physlçian Address
Roma Tono M
Cty, Country Signature of physja
Komenho
Emall

sIGNATUREOF PLAYER: I understand and acknowledge the above diagnosis and the suggested treatment
Thi_ Medlcdal Certificate was Issued followingthe player: Slgnature of player Endorsed by ITF Supervisor
Retiring during a match Completed the tourmament
Withdrew before a Singles WIthdrew efore a Doubles
ITF Fax Number +44 20 8392 4735 A
copy has been given to the player
|CONFIDENTIAL- PHYSICAL FINDINGSs
Temp Pulse TBP Heent

Neck Chest/Heart ABD |EXT

Neuro Other

CONFIDENTIAL - LAB STUDIES,X-RAY FINDINGS

Blood Urine Culture Other

X-Ray findings X-Ray on file at

CONFIDENTIAL - 0THER INFORMATION

N.BI This Medical Certificateedoes not constitute an automatic rawal
|fromother events. It is the player's responsibllity to withdraw from all
tournaments he/she is not able to play..