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The image shows a close-up of a document, likely a medical appointment slip, held by a hand. The document is predominantly white with black text and some handwritten entries. The background appears to be a textured, tiled surface, possibly a floor or wall.

The document itself has several printed fields and sections, mostly in Ukrainian. At the top, it indicates "Дніпропетровська облдержадміністрація" (Dnipropetrovsk Regional State Administration) and "МЕДИЧНА ДОКУМЕНТАЦІЯ" (Medical Documentation). There's a printed date "24.06.2020". The main title reads "ТАЛОН на прийом до лікаря" (Coupon for an appointment with a doctor).

Several fields are visible:
- "Номер медичної карти амбулаторного хворого" (Medical card number of an outpatient patient).
- "1. Прізвище, ім'я, по батькові хворого" (1. Surname, name, patronymic of the patient).
- "2. Місце проживання" (2. Place of residence).
- "3. Номер кабінету" (3. Office number).
- "4. З'явитися" (4. To appear), followed by handwritten entries that appear to be "24" and possibly "рік" (year).
- "5. До лікаря (прізвище)" (5. To the doctor (surname)).
- "6. Діти (віком 0-14 років включно), діти (віком 15-17 років включно), дорослі (від 18 років і старші)" (6. Children (aged 0-14 years inclusive), children (aged 15-17 years inclusive), adults (aged 18 years and older)).
- "7. Звернення з приводу: захворювання, профілактичного огляду, з інших причин, первинне, повторне (необхідне підкреслити, інше дописати)" (7. Reason for visit: illness, preventive examination, for other reasons, primary, repeat (underline as necessary, write additional).

There are also several handwritten marks on the document. A large number "10" is written in the space for the patient's name. There is a signature and some other illegible scribbled writing. At the bottom, there is a printed section "Лікуючий лікар" (Attending physician) with a space for a signature and name in parentheses. A date "20.р." is printed next to it. The number "40" is written in a box in the upper right corner.

The hand holding the document has a light skin tone and is partially obscuring the lower portion. The overall lighting suggests an indoor setting.
Nata1988

Jun 22, 2026

Unknown, Unknown

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The image shows a close-up of a document, likely a medical appointment slip, held by a hand. The document is predominantly white with black text and some handwritten entries. The background appears to be a textured, tiled surface, possibly a floor or wall. The document itself has several printed fields and sections, mostly in Ukrainian. At the top, it indicates "Дніпропетровська облдержадміністрація" (Dnipropetrovsk Regional State Administration) and "МЕДИЧНА ДОКУМЕНТАЦІЯ" (Medical Documentation). There's a printed date "24.06.2020". The main title reads "ТАЛОН на прийом до лікаря" (Coupon for an appointment with a doctor). Several fields are visible: - "Номер медичної карти амбулаторного хворого" (Medical card number of an outpatient patient). - "1. Прізвище, ім'я, по батькові хворого" (1. Surname, name, patronymic of the patient). - "2. Місце проживання" (2. Place of residence). - "3. Номер кабінету" (3. Office number). - "4. З'явитися" (4. To appear), followed by handwritten entries that appear to be "24" and possibly "рік" (year). - "5. До лікаря (прізвище)" (5. To the doctor (surname)). - "6. Діти (віком 0-14 років включно), діти (віком 15-17 років включно), дорослі (від 18 років і старші)" (6. Children (aged 0-14 years inclusive), children (aged 15-17 years inclusive), adults (aged 18 years and older)). - "7. Звернення з приводу: захворювання, профілактичного огляду, з інших причин, первинне, повторне (необхідне підкреслити, інше дописати)" (7. Reason for visit: illness, preventive examination, for other reasons, primary, repeat (underline as necessary, write additional). There are also several handwritten marks on the document. A large number "10" is written in the space for the patient's name. There is a signature and some other illegible scribbled writing. At the bottom, there is a printed section "Лікуючий лікар" (Attending physician) with a space for a signature and name in parentheses. A date "20.р." is printed next to it. The number "40" is written in a box in the upper right corner. The hand holding the document has a light skin tone and is partially obscuring the lower portion. The overall lighting suggests an indoor setting.

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Nata1988

Jun 22, 2026

Unknown, Unknown

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