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BATAAN WOMEN’S HOSPITAL

Sampaguita St. St. Joseph Subdivision


Balanga City 2100
Tel. No. 047-237-1256/09062437678

MEDICAL CERTIFICATE

TO WHOM IT MAY CONCERN:

Per our records, this will certify that ________________________________________________

_______________, ___________, __________________________ and with a given address


(Age) (Sex) (Occupation)
at ___________________________________________________________________________
has/had been confined / treated in this hospital as follows:

Date Admitted: ______________________________ Time: ___________________________


Date Discharged: ____________________________ Time: ___________________________

Final Diagnosis: _____________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Operation: __________________________________________________________________

Remarks : _________________________________________________________________

This certification was issued at the request of _______________________________________

________________________________________and not valid for Medico-Legal Purposes.

____________________________, MD
Attending Physician

License No: ________________________


Date and Time: _____________________

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