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    Physical Examination Form Sheet Blank PSHS

    Uploaded by

    Michael John
    This physical examination form collects health information about a student applying to the Philippine Science High School System. It includes measurements of height, weight, and vital signs. It also requires the examining physician to note any physical or emotional issues and provide a recommendation on the student's ability to adjust to high school life. The physician must also disclose how long they have been treating the student and sign off on the form.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Physical Examination Form Sheet Blank PSHS

    Uploaded by

    Michael John
    244 views1 page
    This physical examination form collects health information about a student applying to the Philippine Science High School System. It includes measurements of height, weight, and vital signs. It also requires the examining physician to note any physical or emotional issues and provide a recommendation on the student's ability to adjust to high school life. The physician must also disclose how long they have been treating the student and sign off on the form.

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    © © All Rights Reserved

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    This physical examination form collects health information about a student applying to the Philippine Science High School System. It includes measurements of height, weight, and vital signs. It also requires the examining physician to note any physical or emotional issues and provide a recommendation on the student's ability to adjust to high school life. The physician must also disclose how long they have been treating the student and sign off on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    244 views1 page

    Physical Examination Form Sheet Blank PSHS

    Uploaded by

    Michael John
    This physical examination form collects health information about a student applying to the Philippine Science High School System. It includes measurements of height, weight, and vital signs. It also requires the examining physician to note any physical or emotional issues and provide a recommendation on the student's ability to adjust to high school life. The physician must also disclose how long they have been treating the student and sign off on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    PHILIPPINE SCIENCE HIGH SCHOOL SYSTEM

    CAMPUS: ______________________________

    ______________________________________________________
    Full Name of Student

    PHYSICAL EXAMINATION FORM FOR GRADE 7 OR LATERAL STUDENT


    (To be accomplished by the Family Physician)

    1. Height __________ Weight __________ For the Examining Physician:


    2. Age __________
    3. Date of Birth ________________________ Comment on any physical or emotional
    4. Eyes: problem that may prevent the student
    From making a good adjustment to
    Visual Acuity w/o glasses high school life in participating to athletics.
    Distant Near _________________________________
    O.D. ______ ______ _________________________________
    O.S. ______ ______ _________________________________
    5. Ears: _________________________________
    Canals R _______ L _______
    Drums R _______ L _______
    Hearing R _______ L _______
    6. Nose: _____________________________
    7. Mouth and Throat How long has the student been your
    Tonsils: Present _____ Out ______ patient? _________________
    Teeth and Gums: ________________
    8. Neck: _______________________________ Recommendation/s:
    9. Chest/Lungs: _________________________` _________________________________
    10. Breast: ______________________________ _________________________________
    11. Heart: ______________________________ _________________________________
    12. Pulse: ______________________________ _________________________________
    13. Abdomen: ___________________________ _________________________________
    14. Hernia: _____________________________ _________________________________
    15. Genitalia: ____________________________ _________________________________
    16. Back/Scoliosis: ________________________ _________________________________
    17. Extremities: _________ Joints __________ _________________________________
    18. Skin: ________________________________
    19. Lymph Nodes: ________________________
    20. Nervous System: ______________________

    _________________________________
    Medical Examiner
    License No. ______________________
    Date of Examination: ________________

    Address:
    _________________________________
    _________________________________
    _________________________________

    PSHS-00-F-HSU-02-Ver02-Rev0-02/01/20

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