You are on page 1of 2

PHILIPPINE GENERAL HOSPITAL

The National University Hospital


University of the Philippine Manila
Medical Records Division
Taft Avenue, Manila

______________________________________________________________________________

Control No: ____20-0063__


OPD No: __20-06-1008_
DATE:_JULY 2, 2021_

MEDICAL CERTIFICATE

TO WHOM IT MAY CONCERN:


This is to certify that EIRA ORATE, 19 years old, residing at
2130 SUTER ST. STA. ANA MANILA has been confined / treated in this hospital from /
on
JULY 2, 2021 under the following circumstances:

DIAGNOSIS: ESSENTIALLY NORMAL AT THE TIME OF EXAMINATION______________


___________________________________________________________
____________________________________________________________
____________________________________________________________
DISPOSITION: FIT TO TRAVEL_______________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

This certification is issued upon the request of EIRA ORATE to use


exclusively FOR TRAVEL purposes only.

DELA CRUZ, MARRIANE, MD.


PHYSISCIAN
LIC# 0096058

You might also like