PGH Form No.

P-530001
Rev. 01 EFF 08 March 2018

PHILIPPINE GENERAL HOSPITAL

Department of Emergency Medicine
the National University Hospital
University of the Philippines Manila
PHIC-Accredited Health Provider
ISO 9001: 2008 Certified

CHART’S COPY
Case Number: 4454576

MEDICO LEGAL CERTIFICATE

Code No. C-004

6 July 2019

TO WHOM IT MAY CONCERN:

This is to certify that according to his/her case record in this hospital,
PAULINE A. LUNA
___________________________________________________, 35
_____________ years old of
UNIT 101 ITOWER BLDG., PADRE NOVAL ST. SAMPALOC, MANILA
__________________________________________________________________ has been
PIA GUANIO (Surgery)
Attended to by Dr/Drs. ____________________________ on/from
5 July 2019
_________________________________ 3:00 PM
at _____________________________________.

Diagnosis/Diagnoses:

Multiple injuries secondary to mauling

Soft Tissue swelling left shoulder, right chest.
Bruises on the neck due to choking.
X X X
Operation Performed:
X X X

In the opinion of the doctor who attended to the patient, under normal conditions without
subsequent complications and/or deeper involvement that may be present but not clinically
apparent at the time of examination, the said physical injury/injuries will require medical
attendance for less than nine (9) days.
This certificate is issued by authority of the Director.

PAULO BALLESTEROS
Chief
Medical Records Division
NOTE: Not valid without dry seal