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 —-