PROVINCE OF NEGROS ORIENTAL

CITY OF GUIHULNGAN
OFFICE OF THE CITY HEALTH OFFICER

NAME: SEVERINO TABAYACYAC

AGE: 37

SEX: M

ADDRESS: Lot 9 Block 10 Lipton Street, City of Guihulngan

ALLEGED PLACE, DATE, TIME OF INFLICTION: August 30, 2016, 3:00 PM, Larena Street,
Guihulngan City, Negros Oriental
DATE AND TIME OF EXAMINATION: August 30, 2016, 4:30 PM
FINDINGS:

Shallow gash on the left arm, above the bicep, 2cm deep
Finding of gunpowder residue on the wound

CONCLUSION:

The above-described physical injury is found in the body of the subject, the age of which is
compatible to the alleged date of infliction.
The gash is consistent with a gunshot that merely grazed the flesh. Such conclusion is supported
by the finding of gunpowder residue inside the wound.

RESPECTFULLY SUBMITTED:
__________________________
TEODORO TOLENTINO, M.D.