DR. CARE PHARMACY
P.O BOX 2000, NAIROBI
CELL: 0708 58 79 94
SICK OFF
Date: _____________
NAME: ____________________________________________________
AGE: ________________________ SEX: _________________________
I.P / O.P No: _______________________________________________
RESIDENCE: ________________________________________________
The above name client name came to our Hospital with complains of
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put on treatment as follows:
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
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She/he is unable to attend work. Kindly consider ______ days as from
_______________________ to ______________________ for _______
Thank you
Yours
Doctor __________________