File:Arbeitsunfaehigkeitsbescheinigung, Wentorf 1955.jpg

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English: Attestation for sick leave; issued in 1955 in Germany (anonymized data).
Deutsch: Arbeitsunfähigkeitsbescheinigung, ausgestellt im Jahre 1955 in Wentorf bei Hamburg.
Text:
Versicherter! Der Schein ist der Kasse sofort einzureichen, sonst Krankengeldverlust! Vorher die Angaben in der unteren Hälfte des Scheins ausfüllen!
Arbeitsunfähigkeitsbescheinigung - Name des Mitglieds [XXX] - Vorname [XXX] - Krankheitsbezeichnung: Traumatische Hirnschädigung - I II III -
Arbeitsunfähig seit 12.8.55 - Länger als eine Woche? ja / Gehfähig? ja / Ist Bettruhe angeordnet? [XXX] - Ausgehzeit? [XXX] -
Arbeitsunfall? Unfall? Folge eines früheren Arbeitsunfalls? Unfallversicherte Berufskrankheit? Verkehrs-, Sport- oder häuslicher Unfall? Schlägerei? Trunksucht? Vorsatz? Versorgungsleiden? Folgen einer früheren nicht behobenen Krankheit?-
Stempel: 14740 Lg. Schl.-H. - Dr. Hans Möller - Wentorf - den 11. AUG. 1955 - Unterschrift-
Vom Versicherten auszufüllen! Ohne diese Angabe kann das Krankengeld nicht berechnet und ausgezahlt (übersandt) werden.-
Sind Sie Kriegsbeschädigter? [XXX]-
Name des Versicherten [XXX] - Vorname und Geburtstag [XXX] - Wohnort und Postanstalt [XXX] - Straße und Hausnummer [XXX] - Arbeitgeber [XXX] - in [XXX]
Date
Source Own work (own scan with CanoScan 4400F)
Author BlackIceNRW


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