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    Medical For Athletes 1 2with Sign

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    Loreta Ancheta Cataina Acierto
    This document is a medical certificate for a student named Priz Aizy C. Dacusin to participate in school sports from lower meets up to Palarong Pambansa. It includes sections for physical examination, event details, and physician signatures for different levels of competition.

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

    Medical For Athletes 1 2with Sign

    Uploaded by

    Loreta Ancheta Cataina Acierto
    3 views2 pages
    This document is a medical certificate for a student named Priz Aizy C. Dacusin to participate in school sports from lower meets up to Palarong Pambansa. It includes sections for physical examination, event details, and physician signatures for different levels of competition.

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    Medical-for-Athletes-1-2with-sign (2)

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    This document is a medical certificate for a student named Priz Aizy C. Dacusin to participate in school sports from lower meets up to Palarong Pambansa. It includes sections for physical examination, event details, and physician signatures for different levels of competition.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    3 views2 pages

    Medical For Athletes 1 2with Sign

    Uploaded by

    Loreta Ancheta Cataina Acierto
    This document is a medical certificate for a student named Priz Aizy C. Dacusin to participate in school sports from lower meets up to Palarong Pambansa. It includes sections for physical examination, event details, and physician signatures for different levels of competition.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
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    Republic of the Philippines MCForm - 1

    Revised as of September 26, 2019 DEPARTMENT OF EDUCATION


    ___________02_____________
    (REGION)
    ______________QUIRINO________________
    (DIVISION)
    MAGSAYSAY ELEMENTARY SCHOOL_
    (SCHOOL)
    MAGSAYSAY SAGUDAY QUIRINO
    (School Address)

    MEDICAL CERTIFICATE

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)


    Republic of the Philippines MCForm - 1
    DEPARTMENT OF EDUCATION
    ___________02_____________
    (REGION)
    ______________QUIRINO________________
    (DIVISION)
    School/Intrams/District Meet Remarks/Findings:
    To Whom It May Concern: MAGSAYSAY ELEMENTARY SCHOOL_
    (SCHOOL) _____________________________ Ht ._______cm FIT
    MAGSAYSAY SAGUDAY QUIRINO Physician/Medical Officer Wt:_______kg
    This is to certify that I have personally examined PRIZ AIZY C. DACUSIN (School Address) (signature over printed name) BP.____________mmHg UNFIT
    Name
    PRC PR:____________bpm
    age 11 sex . FEMALE and have found that he/she is physically fit unfit, LICENSE: PTR NO. RR:____________cpm Date:
    during the time of examination, to join and participate in the lower meets up to Unit/Division Meet Remarks/Findings:

    Palarong Pambansa. _____________________________ Ht ._______cm FIT


    Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg UNFIT
    PRC PR:____________bpm
    Event: _SOFTBALL ELEMENTARY LICENSE: PTR NO. RR:____________cpm Date:
    Regional Meet Remarks/Findings:
    Physical Examination
    _____________________________ Ht ._______cm FIT
    School/ Unit/Division Regional Palarong Physician/Medical Officer Wt:_______kg
    Intrams/District Meet Meet Pambansa (signature over printed name) BP.____________mmHg UNFIT
    Meet PRC PR:____________bpm
    LICENSE: PTR NO. RR:____________cpm Date:
    Normal Normal Normal Normal
    Palarong Pambansa Remarks/Findings:
    1. Eyes YES | NO YES | NO YES | NO YES | NO
    2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT
    3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg UNFIT
    4. Neck YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm
    5. Cardiovascular YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date:
    6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO
    7. Abdomen YES | NO YES | NO YES | NO YES | NO
    8. Skin YES | NO YES | NO YES | NO YES | NO
    9. Genitalia-Hernia (male) YES | NO YES | NO YES | NO YES | NO
    10. Muskuloskeletal: ROM YES | NO YES | NO YES | NO YES | NO
    a. neck YES | NO YES | NO YES | NO YES | NO
    b. spine YES | NO YES | NO YES | NO YES | NO
    c. shoulder YES | NO YES | NO YES | NO YES | NO
    d. arms/hands YES | NO YES | NO YES | NO YES | NO
    e. hips YES | NO YES | NO YES | NO YES | NO
    f. thighs YES | NO YES | NO YES | NO YES | NO
    g. knees YES | NO YES | NO YES | NO YES | NO
    h. ankles YES | NO YES | NO YES | NO YES | NO
    i. feet YES | NO YES | NO YES | NO YES | NO
    11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
    (reflexes)

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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