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COLLEGE OF SUBIC MONTESSORI SUBIC BAY, INC.

“Seipsum Facit Persona”


“Shaping Students’ Lives, Intellects, and World Views”

MEDICAL CERTIFICATE

To whom so ever it may concern,

This is to certify that I have examined Mr./ Miss. ___________________.

He/ she is suffering / not suffering from following diseases:

Asthma Fits
Convulsions
Diabetes
Physical Disability
Hypertension
Mental Disability
Allergy
& have undertaken all vaccination.

I certify that Mr. / Miss __________________________ is physically, mentally &


psychologically fit / unfit to work for 80hrs on Work Immersion Program of the
Senior High School learners.

___________________________, M.D.
Attending Physician
Lic. No. _________________________
PTR. No. ________________________

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