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Pe Routing Slip and Instructions: Camp Pbgen Rafael T Crame, Quezon City

This document outlines the routing slip and instructions for a physical examination (PE) conducted by the Philippine National Police Health Service. It includes 12 steps to guide an applicant through the PE process, from obtaining the appropriate forms to the final evaluation. Key information collected includes the applicant's name, address, contact details, and medical history. The PE then assesses measurements like height, weight, and blood pressure. Examinations of specific areas like the heart, lungs, eyes, ears, dental, and lab tests are also indicated. The routing slip is signed by the applicant and examiner at each step to document progress and results.

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lara michelle
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1K views1 page

Pe Routing Slip and Instructions: Camp Pbgen Rafael T Crame, Quezon City

This document outlines the routing slip and instructions for a physical examination (PE) conducted by the Philippine National Police Health Service. It includes 12 steps to guide an applicant through the PE process, from obtaining the appropriate forms to the final evaluation. Key information collected includes the applicant's name, address, contact details, and medical history. The PE then assesses measurements like height, weight, and blood pressure. Examinations of specific areas like the heart, lungs, eyes, ears, dental, and lab tests are also indicated. The routing slip is signed by the applicant and examiner at each step to document progress and results.

Uploaded by

lara michelle
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

PNP HS FORM NO.

2014-05

2x2 colored picture with white


background and the name should
appear below the picture
Republic of the Philippines
National Police Commission
PHILIPPINE NATIONAL POLICE (LAST, FIRST, M.I. & BELOW IS THE
HEALTH SERVICE RANK).

Camp PBGen Rafael T Crame, Quezon City

CONTROL NO.___________________________________________

PE ROUTING SLIP AND INSTRUCTIONS


NAME: Mulok, Saadodin Macabalang AGE/SEX: ____________________

ADDRESS: ________________________________________________________ CONTACT #: _________________

ÿ NEW APPLICANT
ÿ OLD APPLICANT: Date/Place of Last Application: ______________ __________________ No of Application: ________

______________________________________
Signature Over Printed Name of Applicant

a. Get the appropriate form for the desired examination


1ST STEP b. Fill up Medical History Form and other PE forms completely
c. Read instructions carefully
MEASUREMENTS DATE EXAMINER’S INITIAL

HEIGHT

WEIGHT
2ND STEP
WAISTLINE

BMI

BP

3RD STEP HEART RATE

RESPIRATORY RATE

4TH STEP GENERAL PHYSICAL EXAMINATION


With deficiency No deficiency
5TH STEP EAR EXAMINATION
Visual Acuity
Right Left
6TH STEP EYE EXAMINATION Snellen

7TH STEP EYE EXAMINATION Color Vision (Ishihara)


With deficiency No deficiency
8TH STEP DENTAL EXAMINATION

9TH STEP LABORATORY & X-RAY

10TH STEP ECG

REVIEW OF MEDICAL HISTORY, EVALUATION OF LAB, ECG AND


11TH STEP CXR RESULTS

12th STEP FINAL EVALUATION BY CHIEF MEDICAL DISPENSARY


Signature

[Link]

20.2CY.0000495.BAR PNP HS FORM NO. 2014-05 Republic of the Philippines National Police Commission PHILI

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