Adeverinta medicala pentru inscrierea la facultate

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:

___________________________________________________________________________________

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Rezultatul examenului medical:

- radiologia pulmonara

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- serologia sifilisului

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- examen psihiatric

___________________________________________________________________________________

- examen cardiologic

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I s-a eliberat prezenta pentru a folosi la

_________________________________________________________________________________________________

Data eliberarii:Ziua ____ luna ____ anul _____

Semnatura si parafa medicului

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