Ta’lim olayotgan shaxslar uchun mehnatga layoqatsizlik MA’LUMOTNOMASI 20___ yil “___” _____________
___________-son
Familiyasi, ismi ________________________________________________________
Yoshi ________________________ Jinsi _____________________________________
O‘qish joyi______________________________________________________________
(tashkilot nomi)
Tashxis_________________________________________________________________
Yuqumli kasallikka chalingan bemor bilan kontaktda bo‘lganligi haqidagi
ma’lumotlar
________________________________________________________________________
O‘quv mashg‘ulotlaridan ozod etilgan
kunlar (shu kunlar bilan birga)
20___ yil “_____” _______________ dan
20___ yil “_____” _______________ gacha
Shifokorning F.I.O.
_____________________________
Shifokorning imzosi
_________
Yangi ma’lumotnoma berildi
�20___ yil “_____” _________________ da
___________-son
Davolash-profilaktika muassasasi muhri
(Muassasa shtampi)
138\x shakl
Bemor bolani parvarishlash uchun mehnatga layoqatsizlik MA’LUMOTNOMASI 20___ yil “___” ____________
___________-son
Bemor bola haqidagi
ma’lumotlar:
Familiyasi, ismi, otasining ismi ___________________________________________
Yoshi _______________________ Jinsi ______________________________________
O‘qish joyi ______________________________________________________________
(tashkilot nomi)
Tashxis__________________________________________________________________
Parvarish qiluvchi haqidagi ma’lumotlar: _____________________________________
Familiyasi, ismi, otasining ismi____________________________________________
Qarindoshligi __________________________ Jinsi ___________________________
Ish joyi ________________________________________________________________
(tashkilot nomi)
Ishdan ozod etilgan kunlar:
