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MAKASSED ISLAMIC

CHARITABEL HOSPITAL
MOUNT OF OLIVES
Jeruslem P.O.Box: 19482 19482 ..A
Tet02/6270188 - Fax:02/6270158 02/6270188 :Sla - 02/6270158 ægäli

Ref. No. 761459 761459


2024/08/19
Date: 19/08/2024

Clinic Form

This is to certify that asim hassan husin

ID. 851537464 File No.:


Clinic
Has an appointment at Orthopedic
On 29/08/2024 Day Thursday For Days

Need a Companion: Yes


1. Name of thecompanion
Relationship to the patient ID No.

2. Name of the companion


Relationship to thepatient ID No.

3N Dotor's Name: Dr.* Saifeddin Abu Rub

Abltii CficeeHos
Outptient,ClinisssSea

*Note: Dr. Clinic Does not Need Presence of the Named Dr. by Himself.
J.A./MR.
*C761459C29C8C2024C|C3792605*

3.792,605.00

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