Republic of the Philippines

Province of Eastern Samar
Municipality of CAN AVID

MAIN HEALTH CENTER
MLC No. ________

MEDICO LEGAL REPORT

NAME: RICARDO DELOS REYES SR. AGE: 52 years old SEX: Male CIVIL STATUS: Married

OCCUPATION: Government employee ADDRESS: Brgy. Tawagan, Oras Eastern Samar

ALLEGE DATE /TIME AND PLACE OF INFLICTION: On or about 9:30 AM, February 12, 2017
along Campomanes Street, Brgy. 14, CAN AVID, Eastern Samar

DATE AND TIME OF EXAMINATION: ________________

FINDINGS:

CONCLUSION:
1) Above physical injuries are found in the body of the subject the age of which is
compatible to the allege date of infliction.
2) Under normal condition without subsequent complication and or deeper
involvement is present but not clinically apparent at the time of examination the
above physical injuries will require medical attention or will incapacitate the
victim for a period not less than ______ days but not more than ______ days.

REMARKS:

DR. CCC CCC CCC
Municipal Health Officer

Received by: ________________
Date: ________________

________ MEDICO LEGAL REPORT NAME: LINDA CATUDAY y MORALLOS AGE: 61 years old SEX: Female CIVIL STATUS:Married OCCUPATION: No permanent job ADDRESS: Brgy. 4) Under normal condition without subsequent complication and or deeper involvement is present but not clinically apparent at the time of examination the above physical injuries will require medical attention or will incapacitate the victim for a period not less than ______ days but not more than ______ days. Brgy. Eastern Samar DATE AND TIME OF EXAMINATION: ________________ FINDINGS: CONCLUSION: 3) Above physical injuries are found in the body of the subject the age of which is compatible to the allege date of infliction. Borongan City ALLEGE DATE /TIME AND PLACE OF INFLICTION: On or about 2:00 PM. January 16. 2017 along South Bound Lane of National Highway. Calingatnan. Malaintos. REMARKS: DR. Dolores. ROWIE R ROMUAR Municipal Health Officer Received by: ________________ Date: ________________ . Republic of the Philippines Province of Eastern Samar Municipality of Dolores MAIN HEALTH CENTER MLC No.