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Philippine Academy of Family Physicians, Inc.

Commission on Specialty Board of Examiners

PRIMER FOR EXAMINEES

2016 Diplomate Board Examinations

Prepared by
Commission on Specialty Board of Examinations in Family Medicine

The Certifying Examinations for the title of Diplomate in Family Medicine are administered
yearly by the Commission on Specialty Board of Examiners of the Philippine Academy of Family
Physicians.

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ELIGIBILITY REQUIREMENTS
Those qualified to take the diplomate exams upon the recommendation of the Committee on
MEMBERSHIP are the following:
CME Track:
a Conferred as a certified family physician (CFP)
b. Earned 180 CME units
c. Quality Assurance Workshop Certificate*
d. Endorsement from Chapter President (see appendix)
Residency Training Track:
a Conferred as a certified family physician (CFP)
b. Earned 60 CME credit per year
c. Quality Assurance Workshop Certificate*
d. Endorsement from Chairman and Training Officer (see appendix)
*If QA workshop will be held after the application period, a photocopy of the official
receipt for registration fee should be enclosed. Test results will only be released upon
submission of the QA certificate.
Other Requirements
a. Paid the examination fees
b. Settled all payable accounts to PAFP (e.g. Membership, Convention,
Assessment fees etc.)
c. Signed the consent to agree and abide by the policies and procedures of the
Examination
d. Refresher course certificate of completion for those whose 3-year validity has
lapsed.**
**If Refresher course will be held after the application period, a photocopy of the
official receipt for registration fee should be enclosed. Test results will only be
released upon submission of the Refresher course certificate.

ORIENTATION DATES & VENUES

There will be NO orientation for the Written Examination. All the information can be
found in this primer. The primer will also be emailed to all eligible test takers. Should an
examinee have any questions, he/she can call the PAFP Office (Tel. No. 5162900)
Contact Persons: Mr. RJ dela Cruz Mobile 0917-5486550, email rj.thepafp@gmail.com
Dr. Tricia Bautista at jtbautistamd@yahoo.com.
Orientation for the Oral Examination: First Saturday of December
Date & Time: December 3, 2016, 1:00 to 3:00 pm, to be followed immediately
by the Projection Examination and 2 Unmanned Stations (Part I).
Registration starts at 12:30 pm. Test permits will be issued upon
exhibiting a valid government ID.
Venue:
3/F UST Medicine Building, Computer Resource Learning Center

EXAMINATION DATES
Written Examination: Fourth Sunday of October
Date & Time: October 23, 2016
Registration: 7:15 am - 8:00 am
PART I - 8:00 am 12:00 pm
PART II - 1:00 pm 5:00 pm
Venue:
UST Medicine Building, exact room(s) to be posted at the building
entrance

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Oral Examination: 1st Saturday and 1st Sunday of December
Part 1:

Projection Exams & 2 Unmanned OSCE Stations

Station U1 FM skills: Family Assessment Tools Application
Station U2 EBM skills: Clinical Application of Appraisal of a Journal
Article or Clinical Practice Guidelines

Date & Time: December 3, 2016 Saturday, 3:00- 5:00 pm immediately after
Orientation
Venue:
3/F UST Medicine Building, Computer Resource Learning Center
Part 2:
5 manned OSCE stations
Date & Time: December 4, 2015, Sunday, 7:30 am - 5:00 pm
Venue:
Assigned rooms at the UST Medicine Building
The designated testing rooms, Histology (3/F), Neuroanatomy (3/F)
and Biochemistry (2/F), will be posted at the Department of
Preventive Family and Community Medicine bulletin board, 3 rd floor
beside Room 329 on the morning of the testing day.
In case of extreme weather conditions affecting the testing venues, the examination
dates will automatically be moved to the following week with the same schedule of days
in the week and set time, unless otherwise specified.
Follow us and watch out for announcements at our Facebook page PAFP Specialty
Board Exams 2016

APPLICATION PROCEDURES & REQUIREMENTS

The PAFP Secretariat and the Commission and the Committee on Membership will
perform the proper notification and coordination with those qualified to take the written
exam not later than July 31, 2016.
All applications for written, oral exams or both should be coursed through the PAFP
Secretariat not later than the designated DEADLINES.
Written examination: September 23, 2016, Friday
Oral examination:
November 4, 2016, Friday
Application Requirements:
1) Filled up application form
2) 3 pcs 2x2 most recent colored ID picture with white background labeled and
signed at the back. (2 photos pasted on the test permits)
3) Application fee of Php 3,500.00 for both examinations or Php 1,800.00 for either
oral or written exam only
4) Signed the consent agreeing to the policies and procedures of the Examination
5) Return the completed Test Permits for encoding of Examinee Number.
Permits will be claimed at the testing venue on the day of the examinations.
6) Photocopy of Certificate of Attendance in PAFP Quality Assurance Workshop
7) Photocopy of the Certificate of Completion in Refresher course (only for those
required)
8) Endorsement letter from respective Training Officer and Chairman of the Training
Program; or the Chapter President for CME track. (See appendix)
Submission of the above-mentioned requirements can be done by:
Hand delivery to PAFP Office
Delivered by courier to PAFP Office with address 2244 Taft Avenue, Malate, Manila
1004 Philippines. Attention: Commission on Specialty Board of Examiners
For other concerns: Call PAFP Office (632) 5162900; 0908-8666124; 09328528743
Contact Persons: Mr. RJ dela Cruz Mobile 0917-5486550,
email rj.thepafp@gmail.com

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I. THE WRITTEN EXAMINATION
The written examination intends to assess the examinees level of knowledge in clinical
and family medicine necessary to be considered as a competent family physician after years of
training and practice.
A. CONTENT OF THE WRITTEN EXAMINATION
The written examination proper consists of four hundred (400) multiple choice questions
(MCQs) divided into two (2) sets of 200. Each set is allotted 4 hours to complete. The topics
are mainly based on the latest PAFP Manual of Competencies and are as follows:
1. Clinical Medicine: Child Care, Adult Care & Elderly Care (60% - 240 questions)
2. Family Medicine: other Foundation courses (40% - 160 questions)
B. GENERAL BLUEPRINT FOR THE WRITTEN EXAMINATION
The number of questions and percent distribution per specialty or system (CLINICAL
MEDICINE topics) according to the 5 star physician roles (FM topics) is shown below.
5 STAR
PHYSICIAN
No. of Questions
(% Distribution)

Healer Communicator/
Counselor

Researcher
/Lifelong
Learner

Leader/
Manager

CLINICAL
& FAMILY
MEDICINE

240
(60%)

90
(22.5%)

40
(10%)

10
(2.5%)

Community
Advocate/
Social
Mobilizer
20
(5%)

26

10

40 (10%)

24
12
24
23
12

10
2
10
10
2

4
4
4
5
4

1
1
1
1
1

1
1
1
1
1

40 (10%)
20 (5%)
40 (10%)
40 (10%)
20 (5%)

24

10

40 (10%)

26

10

40 (10%)

13
13

2
2

3
3

2
2

20 (5%)
20 (5%)

23

10

40 (10%)

10

20 (5%)

13

20 (5%)

240

90

40

20

400(100%)

No. of
Questions
(% Distribution)

Neurology/
Musculoskeletal
Respiratory
EENT
Cardiology
GIT/ Nutrition
Hematology/
Immunology
GUT/
Reproductive/
Nephrology
Endocrine/
Metabolic
Dermatology
Mental Health/
Developmental
Infectious
Diseases
Oncology/
Palliative Care
Occupational /
School Health
TOTAL

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As a guide for the examinees, the distribution on the type of questions, according to the
thinking-order skills to be tested, is as follows:
Recall is remembering terminologies, specific facts, trends and sequences,
classifications and categories, criteria, methodology. (10%)
Comprehension is demonstration of understanding of facts, comparing translating,
interpreting, and giving descriptions to specific concept. (10%)
Application is knowledge to solve problems to new situations by applying acquired
knowledge, facts, techniques and rules in a different way. (50%)
Analysis is knowledge to identify causes and find evidences to support generalizations.
(30%)

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The MUST-KNOW topics are the following common conditions but may not be limited to:
Respiratory
Pneumonia, Bronchitis
COPD
Asthma
PTB

Cardio
Hypertension
Coronary Artery Disease
Heart Failure
Congenital Heart/ RHD

Hematology/Immunology
Anemias
Leukemias
Hypersensitivity
Anaphylaxis

Endocrine/Metabolic
Diabetes
Thyroid Diseases
Dyslipidemia
Obesity
Nutritional Deficiencies

GUT/Nephro
UTI, Pyelonephritis
Urolithiasis
Kidney Disease
Glomerulonephritis
BPH

Reproductive
Abnormal uterine bleeding
Myoma uteri
Pregnancy and complications
Sexually Transmitted Infections

Oncology/Palliative
Cervical cancer
Breast cancer
Colorectal Cancer
Liver Cancer
Kidney, prostate cancer
Wilms, Retinoblastoma
Osteosarcoma
Control of
terminal symptoms

Gastro
Dyspepsia, GERD
Ulcers
Acute Appendicitis
Bowel Obstruction
Acute Cholecystitis/Lithiasis
Pancreatitis
Malnutrition
Constipation
Chronic Diarrhea

Infectious
Malaria, Filaria, Schistosomiasis
Dengue, other hemorrhagic fevers
Hepatitis
Measles, other Viral exanthems
Typhoid, Amebiasis
Infectious diarrhea
Meningitis, Mumps
Influenza, influenza-like illnesses
Emerging diseases

Neurology
Stroke
Headache
Insomnia
Dementia
Seizure
Syncope
Febrile Convulsions

Occupational/School Health
Bullying
Occupational violence
Poisoning: Salicylates, alkalis
Acids, INH, Pesticides (OP)
Preventive recommendations
Environmental hazards and
Effects

Mental Health/Developmental
ADHD, Autism
Downs syndrome
Depression, mood disorders
Anxiety Disorders
Insomnia
Alcohol dependency
Addictions

Dermatology
Impetigo
Allergic dermatitis
Seborrheic dermatitis
Acne, Miliaria
Pediculosis, Scabies
Carbuncle, Furuncle
Decubitus ulcers
Insect bites, Urticaria
Pityriasis rosea
Burns
Fungal infections
Skin manifestations of
Systemic diseases

EENT
BPPV
Conjunctivitis,
Differentials of Red Eye
Error of refraction
Glaucoma, Cataract
Blepharitis, Hordeolum
Impacted cerumen
TMJ Dysfunction
Pharyngitis
Hearing Loss
Otitis Media, externa
Allergic rhinitis
Menieres

Others: FM Principles related to

the different roles of a FP:
Healer
Communicator/ Counselor
Researcher /Lifelong Learner
Leader/Manager
Community Advocate/
Social Mobilizer
Also included:
Preventive care
Concepts of the Foundation
courses
Common Emergencies

The agreed major references to be used for the 2016 Specialty Board Examinations are:
a. Leopando et al Textbook of Family Medicine Volume 1 (Principles, Concepts,
Practice and Context) and Volume 2 (Enhancing the Performance of the Five Star
Family Physician) -- for FM principles, EBM, QA, community, research
b. Rakels Textbook in Family Medicine, 9th edition -- for FM principles, Clinical topics
c. Dr. Eva Irene Yu-Maglonzo Geriatrics
d. Dr. Eva Irene Yu-Maglonzo Filipino Family Physician Today 2 nd Edition
e. Filipino Family Physician Journal (last 2 issues of the prior year and 1 st 2 issues of the
current year)
f. CPGs list (international and local) to be available at PAFP website or FB page
Compendium of Philippine Medicine (CPM), 16th
edition 2015.
Allergic Rhinitis
Alzheimers Disease

Below are the latest guidelines in other editions

of CPM and the year:
Acne 13th ed (2011)
Anemia 5th ed (2003)

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Atopic Dermatitis
Dengue
Essential newborn care
Hepatitis B
Interventional cancer pain management
Intrapartum and postpartum care
Low back pain
Upper Gastrointestinal bleeding
Prostatic carcinoma
Skin and soft tissue infections
Wound bed preparation
CPM 17th edition 2016
Adult Immunization Schedule
Bipolar Disorder
Community-Acquired Pneumonia
Coronary Artery Disease
Depression
Diabetes
Hypertension in Older Persons
Immunization Schedule - Child
Rabies
Schizoprenia
Stroke
Urinary Tract Infection
Weight Management

Asthma 12th ed (2010)

Benign Prostatic Hypertrophy 13th ed (2011)
Breast cancer 13th ed (2011)
Cataract 10th ed (2008)
Cervical CA 13th ed (2011)
COPD 4th ed (2002)
Dry eye 9th ed (2007)
Dysmenorrhea 10th ed (2008)
Family Planning 8th ed (2006)
Gout 11th ed (2009)
Hepatitis B in the workplace 14th ed ( 2012)
Hormonal Contraceptives 13th ed (2011)
Human papillomavirus 13th ed (2011)
Insomnia 11th ed (2009)
IMCI 14th ed (2012)
Lung cancer 10th ed (2008)
Diabetes in Pregnancy 6th ed (2004)
National nutrition survey 8th ed (2006)
Neuropathic pain 12th ed (2010)
Nutritional guide pyramid 14th ed (2012)
Osteoarthritis 12th ed (2010)
Osteoporosis 13th ed (2011)
Parkinsons Disease 10th ed (2008)
PCOS 14th ed (2012)
Smoking cessation 14th ed (2012)

Should there be a more updated guideline

other than those listed here or has been
officially released before 01 October 2016,
such guideline will take effect
and will be used as reference.

Latest and commonly cited guidelines

of local specialty societies and
reputable international medical associations/
groups can also be used as reference.

*Please always check FB page PAFP Specialty Board Exams 2016 for announcements
C. CONDUCT OF THE WRITTEN EXAMINATION
1. Qualified examinees should submit the complete requirements to the PAFP Office on or
before the deadline set by the PAFP secretariat.
2. All examinees must be in proper attire: Smart casual. No shorts, no mini-skirts, no
plunging necklines, no slippers will be allowed. Bring sweater or jacket.
3. At the venue, they will register in the assigned room one hour prior to the start of the
examination. The examinee must present a valid government ID (PRC card, Drivers
License, Passport) to claim their TEST PERMIT.
4. Bring two pieces of no. 2 Mongol pencils. Examinee may bring extra pencils, sharpener
and eraser. No pencil case, pens, calculators and the like will be allowed.
5. Seats for the candidates are pre-numbered as indicated on the test permit. No change in
seating arrangement is allowed unless authorized by the examiners.
6. All personal belongings including mobile phones, wrist watch must be kept in their bags,
which will all be placed in the front area of the room. Cellular phones should be turned
off. A big clock will be displayed in the testing rooms.
7. Answer sheets will be machine validated. The Examinee Information (EIS) at the front
and Examinee Answer sheet (EAS) at the back should be filled up properly. The stub on
the side should be detached and kept by the examinee after the examinations. Write
your assigned Examinee Number on the stub for reference. See sample EIS/EAS in the
appendix of this primer for familiarization and practice purposes.
8. No identifying marks shall be placed on the EAS and EIS. Markings can be made on the
questionnaires.

9. Make sure that questionnaires have the complete number of pages.

10. Only Mongol Pencil No. 2 should be used. Shading should not be too light nor too
heavy. Avoid erasures as this may cause machine validation issues.
11. Examinees should make sure that they occupy the same seat number in Part 2.
12. Examinees are allowed to leave the room only for personal necessities and shall be
accompanied by a proctor.
13. Any attempt to communicate with a co-examinee while the examination is ongoing is
presumed cheating. Any concern should be directed to the proctor.
14. All testing permits will be collected and surrendered at the registration table at the end of
the exam.

II. THE ORAL EXAMINATIONS

The OSCE and Projection examinations aim to evaluate the skills and behavior of the
examinee in situations which reflect the competencies of a Family Physician in clinical settings.
The oral examination is focused on the performance of required tasks and procedures needed
to be a health care provider, educator/counselor, manager, social mobilizer, and researcher
whenever applicable.
Part 1: Projection Examination (20%)
All examinees will take the Projection exam after the Orientation on Day 1 (December 3,
2016). Each examinee will be assigned a computer. The examination may include but not
limited to pictures, illustrations and videos of disease manifestations (ex. skin lesions,
fundoscopic findings, etc) and clinic and ancillary procedures (ex. medical imaging, ECG, etc.).
Questions will be on the diagnosis or clinical management. A total of 30 slides will be shown,
each timed at one (1) minute per slide.
A. GENERAL BLUEPRINT OF THE PROJECTION EXAMINATION
Clinical skills
Disease Recognition and Management

Adult and Elderly

60% (18Q)
8

Child
40% (12Q)
4

Diagnostic Interpretation and Analysis

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B. CONDUCT OF THE PROJECTION EXAMINATION

1. All examinees must be in proper attire: Smart casual. No shorts, no mini-skirts, no
plunging necklines, no slippers will be allowed. Bring sweater or jacket.
2. At the venue, registration starts at 12:00 noon. The examinee must present a valid
government ID (PRC card, Drivers License, Passport) to claim their TEST PERMIT.
3. All personal belongings including mobile phones, wristwatch must be secured in their
bags, which will all be placed in the front area of the room. Cellular phones should be
turned off.
4. Seating arrangement will be according to the instructions given.
5. Two sets of examination will be prepared.

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6. Answer sheets will be provided. Black or Blue pens should be used. Erasures are
allowed but must be readable. Handwriting should be legible.
7. Any attempt to communicate with a co-examinee while the examination is ongoing is
presumed cheating. Any concern should be directed to the proctor.
8. Examinee automatically gets zero (0) if he/she misses this part of the oral examinations.
9. No special projection exams will be given
10. The grade for the projection exams represents 20% of the final oral exams grade.
Part 2: Objective Structured Clinical Examination (80%)
The OSCE method of oral examination is used. There will be at least 3 groups of
examiners and examinees conducted in 3 separate rooms with a set of manned stations that
are conducted simultaneously. The examinees will be grouped in advanced according to the
rules set by the Specialty Board.
A. GENERAL BLUEPRINT OF THE OSCE STATIONS (revised 2013)
UNMANNED STATIONS: (Day 1 at the end of the Projection exam)
These stations will be displayed on the same computer after the slide set of the Projection
exam. These two (2) stations will be allotted eight (8) minutes each. Answers to these stations
will be written on the same answer sheet as the projection exam.
Station U1: Family Medicine Skills: Family Assessment Tools Application in a family case
Station U2: EBM Skills: Clinical Application of Appraisal of a Journal Article or Application of
Clinical Practice Guideline (CPG) in a clinical case
MANNED STATIONS: (Day 2)
Station M1: Clinical Skills: Focused History Taking in a clinical case
Station M2: Clinical Skills: PE skills in a clinical case
Station M3: Clinical Procedure Skills: Performing a procedure in a clinical case
Station M4: Clinical Management Decision Skills: Pharmacologic and non-pharmacologic
Management in a clinical case
Station M5: Family Medicine Skills: Family Management and interventions in a family case

B. CONDUCT OF THE OSCE

1. Two (2) unmanned OSCE stations will be conducted after the projection exam on Day 1.
2. On Day 2, all examinees must be in proper attire: Comfortable business (clinic) attire
Example: Long sleeved polo and slacks for men, blouse and slacks for women; and
comfortable shoes. No shorts, no mini-skirts, no slippers will be allowed. Blazers and
sweaters may come in handy.
3. On day 2, examinees should report to their assigned rooms at least 30 minutes before
the start of the examination. Examinees will be divided into groups and all examinees
should stay in the designated holding areas.
4. The examinee must present their TEST PERMIT and a valid government ID (PRC card,
Drivers License, Passport).
5. Medical references and other reading materials are NOT allowed in the holding area.
6. Cellular phones are strictly prohibited in the holding area. These must be turned off and
kept inside the bags.

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7. Toilet break is only allowed while the examinee is in the holding area.
8. The examinee will find a series of rooms known as stations. There will be 5 manned
stations. Some stations are manned by an examiner with simulated patients / actors.
Each station requires the examinee to undertake a set of tasks. The examinee is
expected to perform all the tasks as instructed and shall be graded accordingly using a
scoring checklist.
9. The examinee must bring only their writing pens and test permit at the stations. The
examiner in every station will sign the test permit.
10. Before entering a station is a waiting chair. Two (2) minutes is provided for reading the
case & instructions posted on the chairs armrest. Notes can be written on the scratch
papers provided attached to the testing permit. Another copy of the case and instructions
will also be available inside the station.
11. At the end of the 2-minute period, a bell will ring to signal the examinee to enter the
station proper. Read the case and tasks again if necessary. Perform the tasks required
within eight (8) minutes. A scoring checklist based on the tasks required will be used to
evaluate the performance of the examinee in each station. Questions can only be
directed to the examiner if specifically stated in the instructions or when deemed
necessary.
12. The bell will ring at the end of 8 minutes to signal the examinee to stop immediately and
exit the station proper. At this point, the examinee should proceed to the next waiting
chair to prepare for the next station. If the examinee finishes the tasks before 8 minutes,
he/she must wait inside the station. Casual conversation with the examiner or the patient
during this time should be avoided.
13. The examinee should continue in this manner until all the stations have been completed.
The OSCE is then considered finished.
14. Any attempt to communicate with a co-examinee while they are going through the
stations is presumed cheating.
15. The examinee shall surrender the test permit (together with the scratch papers) to the
area coordinator after finishing all the OSCE stations. The examinee shall also
accomplish the evaluation form.
16. The Chair of the Specialty Board reserves the right to change any OSCE case if there is
a breach or leakage of information or to modify the process at any given time when
deemed necessary.

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III. POLICIES ON THE EXAMINATIONS
1. An eligible examinee has the option to take one (oral alone or written alone) or both exams
(written and oral) in the same year after complying with the requirements.
2. Passing the written examination is NO longer a pre-requisite for taking the Oral Examination.
3. Examinees who passed only one exam are given three (3) consecutive years to take and
pass the remaining exam.
4. Examinees who failed to pass both exams within the 3 year period will invalidate the result of
the exam that was already passed. They shall also be required to take the refresher course
offered by FaMED (Foundation of Family Medicine Educators, Inc.). The certificate of
attendance in the refresher course and compliance of the CME credit requirement are
needed to be eligible to take the exams again and subjected to the same 3-year validity
period if they pass only one exam.
5. Only those who take both exams for the first time in the same year will be eligible to be
considered as the board topnotcher.
6. After registering for the examination, the examinee agrees to abide with all the policies and
procedures stipulated in the primer and the consent form.
7. In case of failure to take the exam for no valid reasons (validity to be decided by the chair),
the examination fees shall be subject to the no refund and forfeiture policy. After deducting
the cost of the review materials and mailing cost, 50% will be refunded if canceled within 7
days after the deadline; and no more refund thereafter.
8. Any form of cheating or dishonesty will disqualify those found guilty. The Specialty Board
may declare a failure of the whole exam if there is massive cheating, breach or leakage of
information of the questions. In such case, another exam will be re-scheduled.
9. The Chairman of the Commission on Specialty Board of Examiners shall recommend to the
PAFP National Board the examinees who have passed both written and oral within the same
year or within the prescribed three year period.
10. The National Board of Directors shall officially endorse the candidates for the title of
Diplomate in Family Medicine to be conferred during the Annual Convention.
11. The successful candidates will be only be officially notified upon approval by the National
Board of Directors.
12. The decision of the Commission on Specialty Board and the National Board of Directors are
considered final and executory.

IV. RELEASE OF RESULTS

For a fair and just conduct of the examination process, the Board of Examiners will set a
mean passing level (MPL) and perform item analysis of the test questions. These shall serve
as a guide to assess the validity, reliability and outcome of the examinations.
Successful examinees will be posted on the PAFP website and Facebook Page using
the Examinee Number indicated on their testing permits. Hence, it is important that the
examinee remembers and notes down his/her examinee number. Official letters indicating the
results of the exams (passed or failed) will then be sent to all examinees by the Commission on
Specialty Board. No more verbal or telephone inquiries on the results of the exams will be
entertained by the PAFP Secretariat.
A formative feedback may be given to those who did not pass the examinations only
when requested in writing and approved by the Specialty Board.
Prepared by:
Ma. Teresa Tricia Guison-Bautista, M.D.
Chair, Commission on Specialty Board, 2016-2017

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PHILIPPINE ACADEMY OF FAMILY PHYSICIANS
#2244 Taft Avenue, Malate, 1004 Manila
Tel. No. 516-2900/405-0140; Tel./Fax: 254-5646
Globe: 09175486550 Smart: 09088666124 Sun: 09328528743
E-mail Address: secretariat@thepafp.org

APPLICATION FOR DIPLOMATE EXAMINATIONS

Deadline of application form and payment for Written: September 23, 2016, Friday
Deadline of application form and payment for Oral:
November 4, 2016, Friday
THE CHAIR
Specialty Board of Examiners
Philippine Academy of Family Physicians
Please be informed that
I am taking both written and oral examinations

Php 3,500

I am taking only the written examination

Php 1,800

Cash

I am taking only the oral examination

Php 1,800

Cheque No.___________

I am not taking the examination

-----

Bank deposit __________

Mode of Payment

Account name: PHIPPINE ACADEMY OF FAMILY PHYSICIANS INC. through any of the branch of the following
banks: BDO S/A No. 004580325004; BPI S/A No. 1623-03116-7; METROBANK S/A No. 509-7-50990454-1. After
deposit has been made, please send the bank deposit slip either by email secretariat@thepafp.org or thru Fax no.
254-5646.

CONSENT
All accounts must be paid on or before the deadline of payments.
No-show during examination: In case of failure to take the exam for no valid reasons, the
examination fees shall be subject to the no refund and forfeiture policy. After deducting the all
the operational costs (materials, mail etc), 50% will be refunded if canceled within seven (7)
days after the set deadline of payments; and no more refund thereafter.
Article XII, Section 11: Any personal inquiry or questions regarding the results of the
examination must be made in writing addressed to the Chair within a month after receiving the
examination results; otherwise, inquiries beyond the allowed period will no longer be
entertained.
Article XII, Section 14: The decision of the CSBEFM and the National Board is final and
executory.
Article XV, Section 3: Any issue raised by an examinee regarding the conduct and results of the
examination will be evaluated by the Chair and/or members of the Specialty Board and shall try
to resolve the matter in their level. Any issue that remains
unresolved will be elevated to the PAFP National Board for final action.
Article XVI, Section 1: The Chair of the Specialty Board is the only person authorized to release
the results of the examination after the presentation to the National Board. Proper procedure for
dissemination shall be followed.
Article XVI, Section 2: Requests for results from any examinee for formative feedback purposes
only will be attended to if a written request is made within 30 days and
after the Specialty
Board Officers have agreed to the request.
I have read and fully understood the implementing rules and regulations of the Specialty Board
Examinations.

Print Name and Signature: _______________________________________________

Chapter / Institution: _____________________________________________________
Mailing Address: ________________________________________________________

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Home / Mobile Nos. _____________________________________________________
Email Address:_________________________________________________________
PHILIPPINE ACADEMY OF FAMILY PHYSICIAN ___
EXAMINEE NO. ________
SPECIALTY BOARD EXAMINATIONS

ORAL EXAMINATION PERMIT

Projection Exam and OSCE
December 3, 2016, Sat, 1:00 pm
December 4, 2016, Sun, 8:00 am

Appendix 1

PHOTO

Permit to be filled up and submitted together with the application form.

It will be claimed upon registration on the day of the examination.
NAME (Surname, First, Middle Initial)____________________________________________________________________
CHAPTER/TRAINING INSTITUTION: __________________________________________________________________
MAILING ADDRESS:________________________________________________________________________________
___________________________________________________________________________________________________
CLINIC/HOSPITAL & ADDRESS______________________________________________________________________
TEL. NO. : ___________________________MOBILE NO/S. ________________________________________________
PRC NO. _________________ PMA NO. ________________ E-MAIL: ________________________________________

Verified by: _____________________________________________________

Examiner

- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - - - -

PHILIPPINE ACADEMY OF FAMILY PHYSICIAN ___

SPECIALTY BOARD EXAMINATIONS

WRITTEN EXAMINATION PERMIT

October 23, 2016, Sunday
8:00 am to 5:00 pm

EXAMINEE NO. ________

PHOTO

Permit to be filled up and submitted together with the application form.

It will be claimed upon registration on the day of the examination.
NAME (Surname, First, Middle Initial)____________________________________________________________________
CHAPTER/TRAINING INSTITUTION: __________________________________________________________________
MAILING ADDRESS:________________________________________________________________________________
___________________________________________________________________________________________________
CLINIC/HOSPITAL & ADDRESS______________________________________________________________________
TEL. NO. : ___________________________MOBILE NO/S. ________________________________________________
PRC NO. _________________ PMA NO. ________________ E-MAIL: ________________________________________

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Verified by: _____________________________________________________
Examiner

ENDORSEMENT FROM DEPARTMENT CHAIRMAN, TRAINING

OFFICER (For Residents) ENDORSEMENT FROM CHAPTER
PRESIDENT (For CME Track)

Appendix 2

Requirement For Taking The Specialty Board Examinations In Family Medicine

Written Examination: October 23, 2016
Oral Examinations:
December 3-4, 2016

CHAIRMANS ENDORSEMENT

I hereby endorse the application of DR. ____________________________________________

to take the written / oral diplomate examinations in Family Medicine.

Chairman (Name and Signature)

_____________________________________________

Institution _________________________________________ Date ___________________

TRAINING OFFICERS ENDORSEMENT

I hereby endorse the application of DR. ____________________________________________

to take the written / oral diplomate examinations in Family Medicine.

Training Officer (Name and Signature)

__________________________________________

Institution _________________________________________ Date _____________________

CHAPTER PRESIDENTS ENDORSEMENT (For CME Track)

Requirement For Taking The Specialty Board Examinations In Family Medicine
Written Examination: October 23, 2016
Oral Examinations:
December 3-4, 2016

I hereby endorse the application of DR. ____________________________________________

to take the written / oral diplomate examinations in Family Medicine.

President (Name and Signature)

_______________________________________________

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Chapter _________________________________________ Date ______________________

Appendix 3

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Appendix 4

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SPECIALTY BOARD OF EXAMINERS
2016-2017

Ma. Teresa Tricia Bautista, MD

Chair

Irmina Concepcion C. Beltran, MD

Member

Marie Ruth A. Echavez, MD

Vice-Chair

Remo G. Benliro, Jr., MD

Member

Ellen May G. Biboso, MD

Secretary

Vivien Fe F. Fadrilan-Camacho, MD
Member

Polly Chua-Chan, MD
Member

Ma. Cecilia Cuaresma-Cruz, MD

Member

Violeta C. Rendon, MD
Member

Imelda Q. Tiglao, MD
Member

Marocel C. Montillano, MD
Member

Raymond Oliver A. Cruz, MD

Member

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Mae Lynn M. Acebuque, MD

Member

Aeesha Y. Pingli, MD
Associate

Dax M. Tidula, MD
Associate

Josephine Yu-Cubillan, MD
Member

Aida D. Capulong, MD
Member

Evelyn A. Siao-Brigino, MD
Associate

Pilar Elena T. Villanueva, MD

Associate

Alma Sheila S. San Miguel, MD

Associate