Department of Education – Schools Division Office of Laguna

Document Title Document No. SGOD-SH-MNS-FO-19-020

Revision No. 0
MEDICAL EXAMINATION MASTERLIST OF
Effectivity Date September 06 , 2019
SPORTS EVENT 1 of 1
Page No.

District:_________________________________ Date: _____________________________________________

School: ___________________________________________ Sports Focal Person:________________________________

_______________________________
(LEVEL)
SY:_________________________

Name of Participant Name of Sports Event Fit to Unfit to Remarks

Play Play

Prepared by:

______________________________
Nurse II

Noted:

_______________________________
Medical Officer III

Registration Mark: Distribution Mark:

This document is updated and controlled if it bears
the red “CONTROLLED COPY” stamp. Otherwise, please
refer to the Control of Documents & Records (CDR) for
your updated copy.