DR. ZENIA M. QUILANTANG-GEDANGONI, M.D., D.F.M., F.P.A.F.

P
Diplomate and Fellow in Family Medicine
Clinic Address: Room 201, Iloilo Mission Hospital Medical Arts Bldg.
Clinic Hours: 4:00-8:00 PM (Mon-Sat)
Tel. No. 320-0315 local 6018

MEDICAL CERTIFICATE
Date _____________
To Whom It May Concern:

This is to certify that patient ______________________________, ____________ years old,

male/female, residing in _______________________________________was seen, history
reviewed and was physically examined. He/ She was assessed to have the following diagnosis:

_______________________________________________________

________________________________________________________

( ) Patient was Admitted ( ) Patient was seen Out- patient

Laboratories requested were:

_______________________________________________________

_______________________________________________________

Medications prescribed were:

_______________________________________________________

_______________________________________________________

He/ She is advised to:

____________________________________________________________

This certification is issued upon the request of Ms/Mr. _________________________.

For whatever purpose this may serve.

ZENIA M. QUILANTANG-GEDANGONI, M.D

License Number: 0074925