misia i krolik
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Strona 1
Signed by /
MEDICAL CERTIFICATE ON SARS-COV-2 RT-PCR TESTING RESULT Podpisano przez:
Tomasz Piotr
ORDER: 1175508221 Anyszek
Date / Data:
2021-05-30 02:20
SURNAME PILECKA
NAME ZOFIA
DATE OF BIRTH 09.10.2002
PLACE OF BIRTH KRAKÓW
TYPE OF IDENTITY DOCUMENT PASSPORT
NUMBER OF IDENTITY DOCUMENT ET8184798
WAS TESTED FOR SARS-COV-2 ON (DATE) 29.05.2021 21:33:13
SARS-COV-2 RT-PCR TESTING RESULT
POSITIVE NEGATIVE
DATE: 29.05.2021
SIGNATURE OF A CERTIFYING PHYSICIAN
TOMASZ ANYSZEK (7770597)
Document with an electronic signature
