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  • Medical Certificate: FOR SCHOOL SPORTS (Lower Meet Up To Palarong Pambansa)

    Uploaded by

    Jan Rose Bantolo Samsona
    294 views2 pages
    This medical certificate certifies that a student was examined by a physician and found physically fit to participate in lower level school sports competitions, including meets up to the Palarong Pambansa. The examination found the student's eyes, ears, nose, throat, mouth, teeth, neck, cardiovascular, chest, lungs, abdomen, skin, and genitalia to be normal. The student's range of motion in the neck, spine, shoulders, arms, hands, hips, thighs, knees, ankles and feet were also found to be normal, as were their neuromuscular reflexes. The physician signed the certificate with their name, license information and date.

    Original Description:

    Form 1

    Original Title

    Medical for Athletes 1

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    This medical certificate certifies that a student was examined by a physician and found physically fit to participate in lower level school sports competitions, including meets up to the Palarong Pambansa. The examination found the student's eyes, ears, nose, throat, mouth, teeth, neck, cardiovascular, chest, lungs, abdomen, skin, and genitalia to be normal. The student's range of motion in the neck, spine, shoulders, arms, hands, hips, thighs, knees, ankles and feet were also found to be normal, as were their neuromuscular reflexes. The physician signed the certificate with their name, license information and date.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    294 views2 pages

    Medical Certificate: FOR SCHOOL SPORTS (Lower Meet Up To Palarong Pambansa)

    Uploaded by

    Jan Rose Bantolo Samsona
    This medical certificate certifies that a student was examined by a physician and found physically fit to participate in lower level school sports competitions, including meets up to the Palarong Pambansa. The examination found the student's eyes, ears, nose, throat, mouth, teeth, neck, cardiovascular, chest, lungs, abdomen, skin, and genitalia to be normal. The student's range of motion in the neck, spine, shoulders, arms, hands, hips, thighs, knees, ankles and feet were also found to be normal, as were their neuromuscular reflexes. The physician signed the certificate with their name, license information and date.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    of 2

    Republic of the Philippines MCForm - 1

    Revised as of September 26, 2019 DEPARTMENT OF EDUCATION


    ________________________
    (REGION)
    ______________________________
    (DIVISION)
    ______________________________
    (SCHOOL)
    ______________________________

    (School Address)

    M E D I CAL C E R T I FI CAT E

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)


    Republic of the Philippines MCForm - 1
    DEPARTMENT OF EDUCATION
    ________________________
    (REGION)
    ______________________________
    h. ankles YES | NO(DIVISION)
    ______________________________
    To Whom It May Concern: i. feet YES | NO(SCHOOL)
    ______________________________
    11. Neuromuscular YES | NO
    This is to certify that I have (reflexes) Name (School Address)

    personally examined
    ___________________ age ____ sex
    School/Intrams/District Meet Remarks/Findings:

    _____ and have found that he/she is


    _____________________________ Ht ._______cm
    Physician/Medical Officer Wt:_______kg
    physically fit unfit,
    (signature over printed name) BP.____________mmHg
    PR:____________bpm
    during the time of examination,
    LICENSE:
    to PTR NO. RR:____________cpm Date:
    join and participate in the lower Remarks/Findings:

    meets up to Palarong Pambansa.


    _____________________________ Ht ._______cm
    Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg
    PR:____________bpm
    Event: LICENSE: PTR NO. RR:____________cpm Date:
    ___________________________ Remarks/Findings:

    _____________________________ Ht ._______cm
    Physical Examination
    Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg
    School/Intrams/
    PR:____________bpm
    District Meet
    LICENSE: PTR NO. RR:____________cpm Date:
    Normal Remarks/Findings:
    1. Eyes YES | NO
    2. Ears, Nose, Throat _____________________________
    YES | NO Ht ._______cm
    Physician/Medical Officer Wt:_______kg
    3. Mouth and Teeth YES | NO
    (signature over printed name) BP.____________mmHg
    4. Neck YES | NO PR:____________bpm
    5. Cardiovascular LICENSE:YES | NO PTR NO. RR:____________cpm Date:
    6. Chest and Lungs YES | NO
    7. Abdomen YES | NO
    8. Skin YES | NO
    9. Genitalia-Hernia (male) YES | NO
    10. Muskuloskeletal: ROM YES | NO
    a. neck YES | NO
    b. spine YES | NO
    c. shoulder YES | NO
    d. arms/hands YES | NO
    e. hips YES | NO
    f. thighs YES | NO
    g. knees YES | NO
    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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