Republic of the Philippines
Department of Education
Region 7, Central Visayas
Division of Bais City
Bais City, Negros Oriental
M E D I CAL C E R T I FI CAT E
________________
(Date)
To Whom It May Concern:
This to certify that I have personally examined _______________________
(Name)
Age_____ sex______ born on _________________________ and have found that he /she is
physically fit, during the time of examination, to join the Regional Schools Press Conference
on December 8-12, 2017 at Cebu City, Cebu.
Physical Examination
Date examined: ________________
Height:___________ Weight: __________ Blood Pressure:_____________
Pulse, Resting:____________________
Other Remarks:____________________________________________________________
_____________________________________________________________
_____________________________________________________________
________________________
_
Physician/Medical Officer
(Signature over printed name)
License No._________________
PTR: ______________________
Date:______________________