Republic of the Philippines

DEPARTMENT OF EDUCATION
X
_______
(Region)
________________________
MISAMIS ORIENTAL
(Division)
LUGAIT CENTRAL SCHOOL
______________________________________________
(School)
POBLACION, LUGAIT MISAMIS ORIENTAL
___________________________________________
(School Address)

MEDICAL CERTIFICATE
September 25, 2017
__________________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined

ROMMEL B. ANORICO
___________________________________________ age36______
yrs. sexM_____ born
Name
JULY 26, 1981
on ______________________ and have found that he/she is physically fit,
during the time of examination, to join and compete in the Unit Meet.
VOLLEYBALL
Event: _______________________________

Physical Examination

Date examined: _______________

Height Weight: Blood Pressure

Pulse, Resting Respiratory Rate
Other Remarks:

Other Findings Yes No If Yes, Pls. specify

Asthma
Food Allergy
Undergone
Operation
Kidney Infection
Heart Ailment
Others

____________________________
Physician/Medical Officer
(Signature over printed name)
License No. _____________
PTR.: ________________
Date: ________________