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Health Form 100km

Dr. Zora Vadnjal-Gruden, born in Ljubljana on March 21st, 1958 and working at the Ambulanta clinic in Kranj, Slovenia, declares that after examining Milan Jeler, born in Kranj on September 3rd, 1968 and residing in Visoko, Slovenia, she found him to be in good health and fit to compete in a 100km ultra marathon based on a sports physical exam conducted on May 11th, 2011.

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39 views1 page

Health Form 100km

Dr. Zora Vadnjal-Gruden, born in Ljubljana on March 21st, 1958 and working at the Ambulanta clinic in Kranj, Slovenia, declares that after examining Milan Jeler, born in Kranj on September 3rd, 1968 and residing in Visoko, Slovenia, she found him to be in good health and fit to compete in a 100km ultra marathon based on a sports physical exam conducted on May 11th, 2011.

Uploaded by

mjel
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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HEALTH FORM

Dr.(first name, last name)


Zora Vadnjal - Gruden, dr.med.

Born (city) Ljubljana On (dd/mm/yyyy) 21/03/1958

Prov.

Country Slovenija

With office at (complete address) Ambulanta, kofjeloka 6, 4000 Kranj Phone n 04 2065349 Fax 04 2065757

Declare myself fully responsabile and acnkowledge the consequences for falsely declaring that Mr. (first name, last name) Milan Jeler Born (city) Kranj On (dd/mm/yyyy) 03/09/1968 And resident at (complete address) Visoko 46,4212 Visoko With the following disability (if applicable) none Based on a sport physical exam done by me on 11/05/2011 is in good health and fit to compete in a 100 km ultra marathon according to the current laws. This certificate is valid one year from this date. In Date Physicians signature 13/05/2011 Prov. Country Slovenija

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