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    نموذج تحويل

    Uploaded by

    raad_alghamdi_1
    This document appears to be a referral form from the Eradh Complex of Mental Health in Riyadh, Saudi Arabia. It contains information about a patient being referred, including their name, age, sex, nationality, and diagnosis. The form is referring the patient to another doctor or department for further treatment, consultation, or investigation. It provides details on the patient's condition, reason for referral, and transportation. Accompanying documents like medical reports and lab results are also noted. The form is dated September 27, 2021 and includes the referring doctor's name and mobile number.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    نموذج تحويل

    Uploaded by

    raad_alghamdi_1
    388 views1 page
    This document appears to be a referral form from the Eradh Complex of Mental Health in Riyadh, Saudi Arabia. It contains information about a patient being referred, including their name, age, sex, nationality, and diagnosis. The form is referring the patient to another doctor or department for further treatment, consultation, or investigation. It provides details on the patient's condition, reason for referral, and transportation. Accompanying documents like medical reports and lab results are also noted. The form is dated September 27, 2021 and includes the referring doctor's name and mobile number.

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    © © All Rights Reserved

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    This document appears to be a referral form from the Eradh Complex of Mental Health in Riyadh, Saudi Arabia. It contains information about a patient being referred, including their name, age, sex, nationality, and diagnosis. The form is referring the patient to another doctor or department for further treatment, consultation, or investigation. It provides details on the patient's condition, reason for referral, and transportation. Accompanying documents like medical reports and lab results are also noted. The form is dated September 27, 2021 and includes the referring doctor's name and mobile number.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    388 views1 page

    نموذج تحويل

    Uploaded by

    raad_alghamdi_1
    This document appears to be a referral form from the Eradh Complex of Mental Health in Riyadh, Saudi Arabia. It contains information about a patient being referred, including their name, age, sex, nationality, and diagnosis. The form is referring the patient to another doctor or department for further treatment, consultation, or investigation. It provides details on the patient's condition, reason for referral, and transportation. Accompanying documents like medical reports and lab results are also noted. The form is dated September 27, 2021 and includes the referring doctor's name and mobile number.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
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    ‫الرقم‬

    Health Care No
    ‫الصحي‬

    Name ‫االسم‬
    Age ‫العمر‬ Sex ‫ذكر‬ ‫الجنس‬

    Eradh Complex of Mental Health Nationality ‫سعودي‬ ‫الجنسية‬


    Medical Referral Center Consultant In- ‫االستشاري‬
    Department of Eligibility for Treatment charge ‫المسئول‬
    and Medical Coordination Center of
    Internal
    .Dept ‫القسم‬ Unit Social ‫الوحدة‬
    Medicine Fraternization
    REFERRAL FORM ‫نـمــوذج تـحـــــويـــــــل‬
    TO DR DEPT
    DESIGNATION HOSPITAL / PHC
    FROM DR DEPT Center of Social Fraternization
    DESIGNATION HOSPITAL / PHC ERADAH COMPLEX IN Riyadh

    DIAGNOSIS

    PATIENT'S CONDITION : Stable  Critical Conscious  Unconscious


    REASON FOR REFERRAL :  Consultion  Admission Treatment
    … Further Investigation Other :
    TRANSPORTATION : Ambulance  Helicopter Air Other:…patient herself…….
    ESCORT : None Doctor  Nure Relative Other:…………..
    DOCUMENTS SENT : Med.Report Lab.Result X_ray  Other:…………..
    Dr.'s Name
    Date : 27/09/2021
    Mobile #
    Print time :<CURRENT_DATE> <CURRENT_TIME> By User ID :<USER_CREATED> DOCUMENT_ID # <DOCUMENT_ID>

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