Translation of Certificate from hospital

OSTROH REGIONAL HOSPITAL

Outpatients’ clinic

STAMP

Ministry of Health Protection of Ukraine

CERTIFICATE #9

issued to citizen —

year of birth —

to certify that her mother —- (1923 year of birth) is really ill, is not able to ambulate without assistance and requires nursing.

diagnosis: chronic ischemic disease of the heart. Cardiac fibrillation. Atherosclerotic coronarocardiosclerosis of the I-II level.

The certificate is issued at demand.

—-

Doctor —-

Head of the Outpatients’ clinic Signature —-