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    2020 MedicalCertificate (Combative)

    Uploaded by

    Dennmark Igut
    This document is a medical certificate for student athletes that includes sections to record visual, physical assessments and interviews of athletes. It includes checkboxes to indicate whether examinations of the head, neck, chest, cardiovascular system, orthopedic system, neurological system, asthma, allergies and medications were normal or abnormal. The certificate also includes questions for the parent about the athlete's medical history and a section for the physician/medical officer to indicate whether the athlete is fit or not fit to play based on the examination and provide their signature, professional regulation commission number and license/physician to practice number.

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

    2020 MedicalCertificate (Combative)

    Uploaded by

    Dennmark Igut
    45 views1 page
    This document is a medical certificate for student athletes that includes sections to record visual, physical assessments and interviews of athletes. It includes checkboxes to indicate whether examinations of the head, neck, chest, cardiovascular system, orthopedic system, neurological system, asthma, allergies and medications were normal or abnormal. The certificate also includes questions for the parent about the athlete's medical history and a section for the physician/medical officer to indicate whether the athlete is fit or not fit to play based on the examination and provide their signature, professional regulation commission number and license/physician to practice number.

    Original Title

    2020_MedicalCertificate(Combative)

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    This document is a medical certificate for student athletes that includes sections to record visual, physical assessments and interviews of athletes. It includes checkboxes to indicate whether examinations of the head, neck, chest, cardiovascular system, orthopedic system, neurological system, asthma, allergies and medications were normal or abnormal. The certificate also includes questions for the parent about the athlete's medical history and a section for the physician/medical officer to indicate whether the athlete is fit or not fit to play based on the examination and provide their signature, professional regulation commission number and license/physician to practice number.

    Copyright:

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

    2020 MedicalCertificate (Combative)

    Uploaded by

    Dennmark Igut
    This document is a medical certificate for student athletes that includes sections to record visual, physical assessments and interviews of athletes. It includes checkboxes to indicate whether examinations of the head, neck, chest, cardiovascular system, orthopedic system, neurological system, asthma, allergies and medications were normal or abnormal. The certificate also includes questions for the parent about the athlete's medical history and a section for the physician/medical officer to indicate whether the athlete is fit or not fit to play based on the examination and provide their signature, professional regulation commission number and license/physician to practice number.

    Copyright:

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

    Republic of the Philippines

    DEPARTMENT OF EDUCATION
    ________________________
    (REGION)
    ______________________________
    (DIVISION)
    ______________________________
    (SCHOOL)
    ______________________________
    (School Address)

    MEDICAL CERTIFICATE REMARKS QUESTION FOR ATHLETE YES NO REMARKS BY PARENT


    (BASED ON VISUAL, PHYSICAL ASSESSMENT & INTERVIEW) (FOR ANY TO BE ANSWERED BY THE
    DATE OF EXAMINATION: _________________________________ ABNORMALITIES) PARENT:
    Is a doctor currently treating you for
    If Athlete had a Concussion in the Medical Examination anything?
    past year. following post period after Normal Abnormal
    Please note if any: Concussion was normal. Have you ever been unconscious or
    ____________________________ had a concussion?

    List of abnormalities not Have you been hit hard in


    General Medical Exam covered in specific system the head in the last 6 weeks?
    Mental Status/ Psychological exams below:
    Brief survey Have you had any headache in the
    Cranial nerves, eyes, pupil last 2 week?
    Head size and reactivity. Fundi,
    Vision by chart (record) Normal Abnormal Do you have any problem in
    Mouth, teeth, throat, nose Normal Abnormal bleeding?
    Temporomandibular joint Normal Abnomal
    Does any disease run in your
    Cervical spine, lymph Normal Abnomal
    Neck family? Sudden unexfected death?
    nodes
    Breath sounds, rib Have you had any surgery?
    Chest tenderness on compession Normal Abnormal
    Pulse/ blood pressure Have you ever had to stay in a
    (record) Normal Abnormal hospital?
    (d) Cardio Vascular System Heart examination: sounds,
    murmurs, heaves, size, Normal Abnormal
    rhythm Name of Athlete: ____________________________ Fit to Play Not Fit to Play
    Upper limb: shoulder Signature Over printed Name of Parent: ___________________________
    (e) Orthopedic System wrist, hand, fingers Normal Abnormal
    District Meet Date Examined: Regional Meet Date Examined:
    Lower limb: (ankle, knee, Normal Abnormal
    hip)
    ___________________________________ __________________________________
    Relaxes Normal Abnormal Physician/Medical Officer Physician/Medical Officer
    (f) Neurological System Verbal responses Normal Abnormal PRC: PRC:
    Motor responses and Normal Abnormal LICENSE: PTR NO. LICENSE: PTR NO.
    balance Division Meet Date Examined: Palarong Pambansa Date Examined:
    (g) Asthma (record) Yes No
    (h) Allergies Type of reaction (record) ___________________________________ ____________________________________
    (i) Medications used Name and dosage (record) Yes No Physician/Medical Officer ____ Physician/Medical Officer
    PRC: PRC:
    LICENSE: PTR NO. LICENSE: PTR NO.

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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