- •Personal medical book s Photograph eries aб
- •Information on the medical book’s owner:
- •Conclusion of the physician on the admission to work according to the results of medical examination
- •Conclusion of the physician on the admission to work according to the results of medical examination
- •Results of laboratory analyses for presence of enteric infections agents
- •Results of laboratory analyses and examination by the specialist in skin and venereal diseases
- •Results of analyses for helminthosis
- •Results of analyses for pathogenic staphylococcus
- •Notes on prophylactic vaccinations
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No. 746297
Personal medical book s Photograph eries aб
[Seal: Ministry of Public Health of Ukraine]
[Seal: Ukraine, city of Odesa. Odesa private school of general education “Kostandi” of the 1st – 3rd degree, of artistic and aesthetic type. Code No. 30377167]
[Seal: Ukraine. Odesa. Daughter Enterprise of Closed Joint-Stock Company “Market Privoz” “Buterbrod”. No. 23987351]
Enterprise that issued the book: Odesa school of general education “Kostandi”
I hereby certify the signature and personality of the book’s owner Shusharina O.L.
Director of enterprise Tokarev G.V.
Novitskyy N.A.
15.11.2004
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No. 746297
Information on the medical book’s owner:
1. Surname: Shusharina
2. Name, patronymic: Olga Leonidivna
3. Year of birth: 28.10.1975
4. Home address: apartment 6, 97 M. Arnautska Str., city of Odesa
5. Profession: Teacher
6. Position: Administrator, waitress.
7. Enterprise: Odesa school of general education “Kostandi”
“Buterbrod” Limited Liability Company
Page 5
Therapist
Diagnosis: Healthy
[Seal: Shevchuk Tetyana Volodymyrivna. Physician]
Conclusion of the physician on the admission to work according to the results of medical examination
Date |
Physician’s conclusion |
Signature, seal |
|
Stamp: Municipal polyclinic No. 12 Examination commission of Prymorsky district of the city of Odesa Medical examination Smear No. 25 of 18.11.2004 RW No. 23 of 18.11.2004 Healthy. To be admitted for work. Head of examination commission for 1 year
Diagnosis: Therapeutically healthy
Stamp: Municipal polyclinic No. 12 Examination commission of Prymorsky district of the city of Odesa Medical examination Smear No. 2 of 19.09.2005 RW No. 1 of 19.09.2005 Healthy. To be admitted for work. Head of examination commission for 1 year
Diagnosis: Therapeutically healthy |
[Signature] [Seal: Shevchuk Tetyana Volodymyrivna. Physician]
[Signature] [Seal: Shevchuk Tetyana Volodymyrivna. Physician]
[Signature] [Seal: Shevchuk Tetyana Volodymyrivna. Physician]
[Signature] [Seal: Shevchuk Tetyana Volodymyrivna. Physician] |
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No. 746297