έΑΧϟ΍ΓΎγ΍ϭϣϟ΍ϰϔηΗγϣ

ΔϳοέϣΓίΎΟΈΑέϳέϘΗ
SICK LEAVE REPORT

Patient Name : FARIS SALEH ALI ALYAMI ϲϣΎϳϟ΍ϲϠϋϥΑ΢ϟΎλαέΎϓ : νϳέϣϟ΍ϡγ΍

File Number : KH00116011 KH00116011 : ϲΑρϟ΍ϝΟγϟ΍ϡϗέ
Nat.ID/Iqama No : 1198027490 1198027490 : ΔϣΎϗϹ΍ϲϧΩϣϟ΍ϝΟγϟ΍ϡϗέ
Gender : MALE έϛΫ : αϧΟϟ΍
Nationality : SAUDI SAUDI : ΔϳγϧΟϟ΍
Occupation : : ΔϧϬϣϟ΍
Place of Work : Other ϯέΧ΃ : ϝϣόϟ΍ΔϬΟ
Date of Visit : 28-04-2024 ˰˰ϫ1445-10-19 : ΔόΟ΍έϣϟ΍ΦϳέΎΗ
Admission Date : 28-04-2024 ˰˰ϫ1445-10-19 : ϝϭΧΩϟ΍ΦϳέΎΗ
Discharge Date : : ΝϭέΧϟ΍ΦϳέΎΗ

Recommendation ΕΎ˰˰˰˰˰˰˰˰˰˰ϳλϭ˰˰˰˰˰˰˰˰˰˰Ηϟ΍
Following medical examination , it is recommended ϲΗϻ΍ϲλϮϧξϳήϤϟ΍ϰϠϋϒθϜϟΎΑ :
Sick Leave for 2 Day(s) ϡΎϳ΃ϡϮϳ 2 : ΔΑΎΘϛΓΪϤϟΔϴοήϣΓίΎΟ·ϪΤϨϣ
Starting From 28-04-2024 to 29-04-2024 ˰˰ϫ 20-10-1445 ϲϟ·˰˰ϫ 19-10-1445 Ϧϣ˱΍έΎΒΘϋ΍ϡΎϳ΃
Follow up before end of sick leave. ϪΗίΎΟ·˯ΎϬΘϧ΍ϞΒϗΞϟΎόϤϟ΍ΐϴΒτϟ΍ΔόΟ΍ήϣ
Referral to medical Committee for following . ΔϴϟΎΘϟ΍ΏΎΒγϷ΍ΪΣϻΔϴΒτϟ΍ΔΌϴϬϟ΍ϰϟ·ϪΘϟΎΣ·
Reasons : : ΏΎ˰˰γϷ΍
Approval of sick Leave. ϲΒτϟ΍ήϳήϘΘϟ΍ΩΎϤΘϋ·
Cannot be treated at this facility. ϰϔθΘδϤϟ΍ϲϓϪΟϼϋϦϜϤϤϟ΍ήϴϏϦϣ
Permanent of partial disability. Δϴότϗϭ΍Δϴ΋ΰΟΓέϮμΑϞϤόϟ΍ϦϋϲΤμϟ΍ϩΰΠϋϰϠϋϝΪΗϪΘϟΎΣ
Others patient was accompanied by his father saleh ϯήΧ΃
ali

Badge No : K22_7293 K22_7293 : ϡϗέϟ΍

Atten.Physician : Dr. SARA ELDISHNAWY ϱϭΎϧηΩϟ΍ΓέΎγ .ΩΐϴΒτϟ΍Ϣγ΍

Create By Badge No : K22_7293 K22_7293 : ˯Ύηϧ·Ϣϗήϟ΍

Creating Physician : Dr. SARA ELDISHNAWY ϱϭΎϧηΩϟ΍ΓέΎγ .Ω ˯Ύηϧ· ΐϴΒτϟ΍Ϣγ΍

Approved by the Director : Dr. Ehssan Al Faraj Ω. : (ϢγϹ΍ ήϳΪϤϟ΍ϖϳΪμΗ

Date : 28-04-2024 ˰˰ϫ1445-10-19 : ΦϳέΎΘϟ΍

This form is electronically signed ΎϳϧϭέΗϛϟ΍ϊϗϭϣΝΫϭϣϧϟ΍΍Ϋϫ

/ ΓΩΎόγ

ϩϼϋ΍Ϫϣγ΍΢οϭϣϟ΍ϰϠϋϲΑρϟ΍ϑηϛϟ΍ΏϠρϥ΄ηΑ˰ϫΦϳέΎΗΑ  ϡϗέϡϛΗϟΎΣ΃ϰϟ·ΓέΎη·

Ϫϧ΄ηΑέΩΎλϟ΍έϳέϘΗϟ΍ϪϳϟΎόΑϥϭΩΟΗϪϳϠϋϑηϛϠϟϩϼϋ·Ϫϣγ΍΢οϭϣϟ΍ϡϛϳΩϟϑυϭϣϟ΍ΔόΟ΍έϣϰϟ·ΓέΎη·
ϱέ΍ΩϹ΍ήϳΪϤϟ΍ήϳΪϤϟ΍
ϡ˰˰˰˰˰˰˰˰˰Η˰˰˰˰˰˰Χϟ΍
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