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Medical Cert

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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:______________________

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