St.

Jude General Hospital & Medical Center

Dimasalang cor. Don Quijote Sts., Sampaloc, Manila
Tel. Nos. 731-2761 to 65/740-4163/740-4160/740-4159

MEDICAL CERTIFICATE

November 17, 2019

To whom it may concern:

This is to certify that Mr./Ms./Mrs. ., 45 year old male, presently residing in

Sampaloc, Manila has been consulted as outpatient on November 16, 2018 at
7:15pm.

PRIMARY IMPRESSION:

This certification is being issued upon the request of Mr/Ms/mrs. to be used

exclusively for non-medico legal purposes.

Attending Physician