Remedios Trinidad Romualdez Hospital

Calanipawan Road, Tacloban City

(053) 325-0000

ANNEX A

MEDICAL REPORT

Name of Patient: __ PIOLO PASCUAL_ Patient No. _01256_

Age: __71__Sex: __Male__

Civil Status: __Married_____

Address: 456 V&G Subdivision, Tacloban City, Leyte, Philippines

Date Admitted: _02-15-10_

Room No. _231_

Alleged Place, Date and Time: _456 V&G Subdivision, Tacloban City, Leyte,
Philippines February 15, 2010 at around 9:00 pm_
Date and time of examination: __February 15, 2010, 11:00 pm__

FINDINGS:
GS unconscious, per stretcher
Chief Complaint: Difficulty of breathing, chest pains and loss of
consciousness.
Further examination suggested cardiac arrest.
Resuscitation was administered and patient regained consciousness.

CONCLUSION:
Patient had suffered a cardiac arrest due to malfunction of life support
system.

REMARKS:
Patient in stable condition but requires constant life support system.

Respectfully Submitted,
DAYD PUHL, M.D.
Medico-Legal Consultant
License No. 12345