Adeverinta medicala pentru inscrierea la facultate Judetul _______________ Nr. carnet sanatate _______________ Localitatea _______________ Unitatea sanitara _______________ ADEVERINTA MEDICALA Se adevereste ca _______________________________________________________ , sexul M / F, data nasterii: anul ____ luna ____ ziua _____ , domiciliat/a in localitatea _______________ , judetul _______________ , adresa _______________________________________________________________________ __________________________ Se afla in evidenta noastra suferind de: _______________________________________________________________________ __________________________ Concluziile examenului medical: _______________________________________________________________________ __________________________ _______________________________________________________________________ __________________________ Rezultatul examenului medical: - radiologia pulmonara _______________________________________________________________________ __________________________ - serologia sifilisului _______________________________________________________________________ __________________________ - examen psihiatric _______________________________________________________________________ __________________________ - examen cardiologic _______________________________________________________________________ __________________________ I s-a eliberat prezenta pentru a folosi la _______________________________________________________________________ __________________________ Data eliberarii: Ziua ____ luna ____ anul _____ Semnatura si parafa medicului ______________________________