Republic of the Philipines

Department of Education
IV – A CALABARZON
(Region)
TAYABAS CITY
(Division)
LUIS PALAD INTEGRATED HIGH SCHOOL
(School)
Brgy.Ipilan Tayabas City
(School Address)

MEDICAL CERTIFICATE

October 09, 2019

(Date)

To Whom It May Concern:

This is to certify that I have personally examined Adrian P. Pacaigue

age 17 sex Male born on February 8, 2002 and have found that he/she is

physically fit during the time of examination, to undergo work immersion in your company.

Physical Examination

Date examined: ________________

Height______________ Weight________________ Blood Pressure ___________________

Pulse resting _______________________Respiration ______________________________

Other Remarks:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

SHARLENE V. BAER
License No. 0389475
Nurse II-LPIHS

DR. CONNIE S. SIA

License No. 104077
Medical Officer III
City Division of Tayabas