Cong. Simeon G.

Toribio Memorial Hospital

Poblacion Carmen Bohol
TeleFax No. (038) 501-4456, Tel. No. (038) 411-8798
Email: csgtmhhelp@gmail.com.ph

MEDICAL REPORT
MLC No: 12A
Name of Patient: JULIO B. QUIETA
Age: 60 yo Sex: Male Address: Sitio Binitian, Bugsok Sierra Bullones Bohol
Occupation: Farmer
Date & Time of Examination: August 10, 2019/ 4:00 PM
Place of Examination: Cong. Simeon G. Toribio Memorial Hospital
Examined in the presence of: Ricarda G. Quieta
Relationship to the Patient: Wife
Signature
Examinee: In the presence of:
Identification Marks:
Black mole present over the left cheek, 6 cm outer to the left angle of the mouth
General Condition of the Patient:
Patient subject of examination is conscious. Found to have several wounds in both forearms and
in the palmar portion of right hand, minor contusions in the lower right portion of neck, abrasions in
the left knee and lower elbow of both arms with some blood stains in clothing. Wounds has been
disinfected but bleeding.
General Examination:
Built Height: 157.48 cm Weight: 56 kg
Pulse rate: 110 bpm Temperature: 36.8 degrees Celsius

SI No. 8
Type of Injury: minor contusions, laceration and incised wounds, , abrasions
Site & Size of Injury:
 minor contusions in the lower right portion of the neck characterized by patterned finger
pad bruises associated with abrasions
 Non-fatal slash injuries: single deep laceration in the left forearm and a medium laceration in
the right forearm
A lacerated oblique wound in the ulnar aspect of his left forearm extending through full
thickness of the epidermis and dermis with inflamed edges measuring 6.5x6cm with 10
stitches applied.
 Abrasions in the lower elbow of both arms
 Two incised wounds in the palmar portion of the right hand measuring 3x2.5cm and 4x3cm
with 5 stitches applies
 Minor abrasions in the Left knee
Nature of Injury: injury
Type of Inflicting weapon: Single-edged blunt cutting weapon with a sharp pointed tip
Age of Injury : Fresh Abrasions, Lacerated and incised wounds had inflamed skin edges
Remarks:
10 stitches required for the lacerated wound in the left forearm, 5 stitches required for the
incised wounds, Treatment such as TT (Tetanus Toxoid injection), dressing, stitching
required.

This is to certify the patient Julio B. Quieta was examined and treated by the undersigned at
the the place, date and time specified above.
This further certifies that the above-named patient requires medical attention for more than
thirty (30) days.

DR. ANDREW J. SEVILLA, MD

Attending Physician