na proхojdeniye predvaritelnogo
meditsinskogo osmotra
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Shtamp organizatsii
Napravleniye na proхojdeniye predvaritelnogo meditsinskogo osmotra
Familiya ____________________________ Imya _________________________________ Otchestvo _______________________ God rojdeniya _________________________ Opasniye i vredniye faktori rabochego mesta ______________________________________
Prilojeniye N 1 _____________________ Prilojeniye N 2 _____________________ Podpis ____________________________
Zaklyucheniye meditsinskoy komissii
k rabote po spetsialnosti _________________
v neblagopriyatniх usloviyaх truda
protivopokazaniy net Glavniy vrach lechebno-profilakticheskogo uchrejdeniya _____________________________
Vrach (vrach-terapevt) vrachebnogo uchastka organizatsii __________________________
"_____" _____________ 20___ goda
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Blank-vkladish v meditsinskuyu kartu ambulatornogo bolnogo (f. N 025-u)
Rezultati predvaritelnogo meditsinskogo osmotra
Familiya _____________________________ Imya __________________________________ Otchestvo _________________________ God rojdeniya __________________________
Zaklyucheniye meditsinskoy komissii
K rabote po spetsialnosti ________________ _______________________________________ _______________________________________
v neblagopriyatniх usloviyaх truda
protivopokazaniy net Vrach (vrach-terapevt) vrachebnogo uchastka organizatsii ___________________________
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