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Medical Certificate: Division of Samar

This medical certificate certifies that an individual named ______________, age ______, sex ______, born on __________, was found physically fit after examination to participate in a specific event or contest on the date examined. The certificate provides the person's height, weight, blood pressure, pulse, respiratory rate, and any other remarks from the examining physician, along with their signature, license number, and date.

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Wen Gab Dac
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1K views1 page

Medical Certificate: Division of Samar

This medical certificate certifies that an individual named ______________, age ______, sex ______, born on __________, was found physically fit after examination to participate in a specific event or contest on the date examined. The certificate provides the person's height, weight, blood pressure, pulse, respiratory rate, and any other remarks from the examining physician, along with their signature, license number, and date.

Uploaded by

Wen Gab Dac
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Education
Regional Office No. VIII
Division of Samar
Catbalogan City

MEDICAL CERTIFICATE

Date_______________________________

To Whom It May Concern:

This is to certify that I personally examined _________________________________________,


age _____________, sex ______________ born on ________________________ and have found that
she/he is physically fit, during the time of examination, to join and compete in
_______________________________________________________________.

Specific Event/Contest: _______________________________________

Physical Exanimation:

Date Examined______________________________________

Height: ____________ Weight: __________ Blood Pressure: _______________

Pulse, Resting: ______________ Respiratory Rate: __________________

Other Remarks: _________________________________________________________________


______________________________________________________________________________
______________________________________________________________________________

______________________________
Physician/Medical Officer
(Signature over Printed name)

License No.____________________
PTR__________________________
Date_________________________

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