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ASIA MEDIC FAMILY HOSPITAL and MEDICAL

CENTER
Old Sampaloc Road, Brgy. Sampaloc I, City of Dasmarinas, Cavite
Tel. no. (046) 416-1110

Caring For You and Your Family

MEDICAL CERTIFICATE
Date: .

Signature of the Patient:

I, Dr. . after careful personal examination of the case hereby certify


that Mr. /Ms.

.. . whose signature is given

above, is suffering from that I consider that a period of


absence from school for . with effect from to is
absolutely necessary for the restoration of his/her health.
This certification is issued upon the request of Mr. /Ms. . For whatever legal
purpose.

Physician ............................................
Ma. Theresa Reyes - Concepcion, MD, FPSP
PRC No.
PTR No.
S2 No. ...