‫ﺗﻘﺮﻳﺮ إﺟﺎزة ﻣﺮﺿﻴﺔ‬

Sick Leave Report

GSL20011601810

Qatif Central Hospital states that patient MOHANAD HASSAN AHMED ALALW ‫ﻳﻔﻴﺪ ﻣﺴﺘﺸﻔﻰ اﻟﻘﻄﻴﻒ اﻟﻤﺮﻛﺰي ﺑﺄن اﻟﻤﺮﻳﺾ ﻣﻬﻨﺪ ﺣﺴﻦ اﺣﻤﺪ اﻟﻌﻠﻮ ﺻﺎﺣﺐ اﻟﻬﻮﻳﺔ رﻗﻢ‬
Holder of ID Number 1107368563 has been given a sick leave report for 1 of days -05-1441 ‫ إﻟﻰ ﺗﺎرﻳﺦ‬21-05-1441 ‫ ﻣﻦ اﻷﻳﺎم ﻣﻦ ﺗﺎرﻳﺦ‬1 ‫ ﻗﺪ ﻣﻨﺢ إﺟﺎزة ﻣﺮﺿﻴﺔ ل‬1107368563
from 2020-01-16 to 2020-01-16 : ‫ ﺣﺴﺐ اﻟﺘﺎﻟﻲ‬21

Patient’s Information ‫ﺑﻴﺎﻧﺎت اﻟﻤﺮﻳﺾ‬

Medical Record Number: 513989 513989 : ‫رﻗﻢ اﻟﺴﺠﻞ اﻟﻄﺒﻲ‬

National ID Number : 1107368563 1107368563 : ‫ اﻹﻗﺎﻣﺔ‬/ ‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ‬

Full Name : MOHANAD HASSAN AHMED ALALW ‫ ﻣﻬﻨﺪ ﺣﺴﻦ اﺣﻤﺪ اﻟﻌﻠﻮ‬: ‫اﻻﺳﻢ اﻟﻜﺎﻣﻞ‬

Sick Leave Date : 2020-01-16 21-05-1441 : ‫ﺗﺎرﻳﺦ اﻻﺟﺎزة‬

Gender :Male ‫ ذﻛﺮ‬: ‫اﻟﺠﻨﺲ‬

Date of Birth : 2000-04-17 12-01-1421 : ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬

Nationality : Saudi Arabia ‫ اﻟﺴﻌﻮدﻳﺔ‬: ‫اﻟﺠﻨﺴﻴﺔ‬

Visit Date :2020-01-16 21-05-1441 : ‫ﺗﺎرﻳﺦ اﻟﺪﺧﻮل‬

Discharge Date : 2020-01-16 21-05-1441 : ‫ﺗﺎرﻳﺦ اﻟﺨﺮوج‬

Revisit Date : 2020-01-16 21-05-1441 : ‫ﺗﺎرﻳﺦ اﻟﻤﺮاﺟﻌﺔ‬

Recommendation ‫اﻟﺘﻮﺻﻴﺎت‬

Sick Leave for 1 days ‫ أﻳﺎم‬1 ‫ﺗﻢ ﻣﻨﺤﻪ إﺟﺎزة ﻣﺮﺿﻴﺔ ﻟﻤﺪة‬

From :2020-01-16 21-05-1441 : ‫ﻣﻦ ﺗﺎرﻳﺦ‬

To : 2020-01-16 21-05-1441 : ‫ﺣﺘﻰ ﺗﺎرﻳﺦ‬

Consultation Date : : ‫ﻣﺮاﺟﻌﺔ اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ ﻗﺒﻞ اﻧﺘﻬﺎء إﺟﺎزﺗﻪ‬

Attending Physician Information ‫ﺑﻴﺎﻧﺎت اﻟﻄﺒﻴﺐ اﻟﻤﻌﺎﻟﺞ‬

Name : RAFAT FATHI ALOSTA ‫ رأﻓﺖ ﻓﺘﺤﻲ أﺣﻤﺪ اﻷﺳﻄﺔ‬: ‫اﻻﺳﻢ‬

Position : Registrar ‫ ﻃﺒﻴﺐ ﻧﺎﺋﺐ‬: ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬

Alternate Physician Information ‫ﺑﻴﺎﻧﺎت اﻟﻄﺒﻴﺐ اﻟﻤﻨﺎوب‬

Name : : ‫اﻻﺳﻢ‬

Position : : ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬