Doctor: Hello!

In view of my stable condition, I can take care of myself completely in my daily life. I urgently need to take a temporary leave to go out to deal with business today. The leave time will be returned from _ _ today to _ _ _ _ _ _ _ _ _ _. When I am not in the department, if I find that I am not in the hospital bed and I am punished by "hanging the bed empty", I am willing to bear all hospitalization expenses at my own expense and no longer enjoy any policies of medical insurance or the new rural cooperative medical system, including the responsibility of punishment related to medical insurance and rural cooperative medical policy. During my absence from the department, any accident happened to me has nothing to do with Zhumadian Orthopedic Hospital, and all responsibilities are borne by myself and my family.

hereby apply.

Patient himself (signature+fingerprint): Tel: Agree Doctor:

Time: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ................ 24 ...

sick leave note 2:

inpatient department:

patients (in bed) need to take temporary leave to go out for personal reasons (reasons for leave:

going home, working, eating, shopping, and others), and the time for leave is: from. The doctor or nurse on duty strongly urged me to stay in the hospital, and explained to me the unpredictability of the disease itself and the possible accidental risk of going out. The hospital has perfected the obligation of informing, and I promise to go to the hospital to cooperate with the doctor in rounds before 8: every morning during my stay in the hospital. All consequences caused by the patient's going out are at my own risk, and have nothing to do with the hospital.

Asking for leave: Relationship with the patient:

Tel:

Year, Month, Day

Sick leave note 3:

Inpatient Department:

I am an inpatient, and I am asking for leave because I have something important to do. The leave time will be returned from month, day and hour to month, day and hour. During my absence, any accident happened to me has nothing to do with XX Hospital, and all responsibilities shall be borne by myself and my family.

Tel:

Patient himself (signature+fingerprint): Resident's signature:

Time: Year, Month, Day and Time.