Tasdiqlash haqida

Mastlik holati bo‘yicha mehnatga layoqatsizlik
MA’LUMOTNOMASI
20___ yil “___” _____________
___________-son
Familiyasi, ismi_________________________________________________________
Yoshi _______________________ Jinsi ______________________________________
Ish joyi _______________________________________________________________
(tashkilot nomi)
Tashxis _________________________________________________________________
Yakuniy tashxis ___________________________________________________________
Layoqatsizlik turi
_________________________________________________
(kasallik, ishlab chiqarishdagi, turmushdagi baxtsiz hodisalar)
Tartib _________________________________________________________________
(ambulator yoki statsionar)
Shifoxonada bo‘lgan davri
20___ yil “_____” __________________
20___ yil “_____” ________________dan
20___ yil “_____” _______________ gacha
TIEKga yo‘llangan sana
20___ yil “_____” _________________
Shifokorning imzosi
__________
TIEK ko‘rigidan o‘tgan sana
20___ yil “_____” ___________________
TIEK xulosasi
__________
Vaqtincha boshqa ishga o‘tkazilsin
20___ yil “_____” _______________ dan
20___ yil “_____” _______________ gacha
Bosh shifokor imzosi
__________
TIEK raisining imzosi va TIEK muhri
__________
Ishdan ozod etilgan kunlar
(shu kunlar bilan birga)
20___ yil “_____” _______________ dan
20___ yil “_____” _______________ gacha
Shifokorning F.I.O.
______________________________
Shifokorning imzosi
__________
Ishga tushish sanasi (so‘z bilan yoziladi)
______________________________
Yangi ma’lumotnoma berildi
20___ yil “_____” _________________ da
___________-son
Davolash-profilaktika muassasasi muhri

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Mehnatga layoqatsizlik varaqalarini
berish tartibi to‘g‘risidagi
yo‘riqnomaga
4-ILOVA
(Muassasa shtampi)
095\x shakl