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    Third Medical

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    Nanay & The Gang

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    © All Rights Reserved
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    Third Medical

    Uploaded by

    Nanay & The Gang
    4 views2 pages

    Copyright

    © © All Rights Reserved

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    Copyright:

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    4 views2 pages

    Third Medical

    Uploaded by

    Nanay & The Gang

    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

    Revised as of September 26, 2019

    Republic of the Philippines MCForm - 1


    DEPARTMENT OF EDUCATION
    SOCCSKSARGEN
    (REGION)
    SULTAN KUDARAT
    (DIVISION)
    ISULAN NATIONAL HIGH SCHOOL
    (SCHOOL)
    KALAWAG II, ISULAN, SULTAN KUDARAT
    (School Address)

    MEDICAL CERTIFICATE

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)


    Republic of the Philippines MCForm - 1
    DEPARTMENT OF EDUCATION
    SOCCSKSARGEN
    (REGION) School/Intrams/District Meet Remarks/Findings:
    SULTAN KUDARAT
    To Whom It May Concern: (DIVISION)
    _____________________________ Ht ._______cm FIT
    ISULAN NATIONAL HIGH SCHOOL
    Physician/Medical Officer Wt:_______kg
    This is to certify that I have personally examined ZHEDRICK KLYD O. (SCHOOL)
    (signature over printed name) BP.____________mmHg UNFIT
    KALAWAG
    Name II, ISULAN, SULTAN KUDARAT
    PRC
    (School Address) PR:____________bpm
    DOLOJO. age 16 sex MALE and have found that he/she is physically fit LICENSE: PTR NO. RR:____________cpm Date:
    unfit, during the time of examination, to join and participate in the lower meets up Unit/Division Meet Remarks/Findings:

    to Palarong Pambansa. _____________________________ Ht ._______cm FIT


    Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg UNFIT
    PRC PR:____________bpm
    Event: SWIMMING 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. Musculoskeletal: 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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