4
Anexă
la Ordinul MS şi PS nr. 116
din 25 aprilie 2005
Ştampila de antet a
Instituţiei Medico-Sanitare Publice
CERTIFICAT nr.___
privind caracterul vătămării corporale
Eliberat ____________________________________________________________________
Prin prezentul se certifică, ca accidentatul(a) ____________________________________________
în vîrstă de ______sex ____ adresa domiciliului__________________________________________
profesia, funcţia_____________________________ a fost internat la data de__________ ora _____
în secţia ___________________________________ a IMSP _______________________________
A fost stabilită diagnoza_____________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Rezultatul investigaţiilor____________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Tratament, recomandări la externare___________________________________________________
________________________________________________________________________________________________________________________________________________________________
Externat la data___________________________________________________________________
Şef secţie________________________________________________________________________
Ştampila IMSP
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