BATAAN PENINSULA STATE UNIVERSITY City of Balanga. 2100 Bataan Philippines BPSU-SASO-005 (Revision 1. October 2017) MEDICAL EXAMINATION RECORD Name: WONIZL P- ZAUSA ‘Address: TOWNSTE .Linay, paTaael Birth date: OCTo pee 27,1997 Sex: TALE Place of Birth: BALANGA city, BATAAN tionality: FILIPINS j Past Medical History: —— [Weight | Height [GS hs. | leper: Tuberculosis Q Bronchial Asthma [BP >| PR | Hepatitis Epilepsy | ‘rly SG Typhoid Hear Diseases See Dengue oe J MK, rl lu sxually Transmitted Diseases . thers: Last Menstrual Period (I* Day of Last Mens): Pertinent Physical Examination Findings: HEENT: "Dermal Abnormalities: Chest & Lungs = €Sormal Abnormalities: Heart Som al Abnormalities: Abdomen: Normal Abnormalities: _ Genitalia: ‘ONormal ‘Abnormalities: Skin & Extremities: ONornal Abnormalities: Laboratory Results: ‘Complete Blood Count: © Normal Urinalysis: ONormal Fecalysis: OvNormal ‘Abnormalities: Chest X-Raj Normal Abnormalities: ‘HelShe betongs to: Class A- Physically fit for any work. (__) Class B- Physically underdeveloped or with correctable defects (error of refrection, dental caries, defective hearing and similar defects) but otherwise fit to work. (____) Class C- Employable but owing to certain impairment (heart disease, hypertension, anatomical defects, etc.) require placement or limited duty in a specified assignment requiring follow up treatment periodic evaluation. (_) Class D- Unfit or unsafe for any type of employment (active PTB, advance heart disease with threatened failure, malignant hypertension and other similar illnesses). Te (oye ke cspeaasits