Republic of the Philippines
Province of Leyte
                                     Municipality of San Miguel
                              MUNICIPAL HEALTH OFFICE
To Whom It May Concern,
        This is to certify that ______________________________, ____ years old, female, a resident
of Brgy. Libtong, San Miguel, Leyte was seen and examined this _________________ at RHU – San
Miguel, Leyte with the following findings:
       BP: __________________
       HR: __________________
       Temp.: _______________
Diagnoses:
_____________________________________________________________________________________
_____________________________________________________________________________________
________.
       This certification is issued this ____ of ____________2024, for any purposes this may serve.
                                                                        PATRICK NANZ O. BUATIZ,
                                                MD
                                                                           Lic. NO. 136223
                                                                        Municipal Health Officer