Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 1 views

    Medical-for-Athletes-1

    Uploaded by

    FranciscO Pascual

    Copyright:

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

    Medical-for-Athletes-1

    Uploaded by

    FranciscO Pascual
    1 views2 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

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

    Medical-for-Athletes-1

    Uploaded by

    FranciscO Pascual

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    You are on page 1of 2

    Republic of the Philippines MCForm - 1

    Revised as of September 26, 2019 DEPARTMENT OF EDUCATION


    I
    (REGION)
    ILOCOS NORTE
    (DIVISION)
    CAESTEBANAN NATIONAL HIGH SCHOOL
    (SCHOOL)
    #14 SINAMAR, BANNA, ILOCOS NORTE
    (School Address)

    MEDICAL CERTIFICATE

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)


    Republic of the Philippines MCForm - 1
    DEPARTMENT OF EDUCATION
    I
    (REGION)
    ILOCOS NORTE
    (DIVISION)
    School/Intrams/District Meet Remarks/Findings:
    To Whom It May Concern: CAESTEBANAN NATIONAL HIGH SCHOOL
    (SCHOOL) _____________________________ Ht ._______cm FIT
    #14 SINAMAR, BANNA, ILOCOS Physician/Medical
    NORTE Officer Wt:_______kg
    This is to certify that I have personally examined BAPTISTA, SHERLYNE G. (School Address) (signature over printed name) BP.____________mmHg UNFIT
    Name
    PRC PR:____________bpm
    age 1 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: ATHLETICS BOYS SECONDARY 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)

    You might also like