Form No.

: IFD-COP-MCDS004-001
Revision No.: 00
BOHOL ISLAND STATE UNIVERSITY Effectivity Date: August 12, 2020
Zamora, Bilar, Bohol
Related
COP-MCDS-004
Process:
STUDENT MEDICAL WAIVER

I, ____________________________ (Full Name Ex. Juan Dela Cruz) enrollee for the 1st
Semester of A.Y. 2020-2021 in ______________________________ (Course Ex. BS Electrical
Engineering).

I am fully aware thatamong others, the requirementsfor enrolment are (Please tick all medical
requirements below that are applicable to your course.):

HBsAg (For Health and Allied Sciences coursesand Food handlers)

Sputum Examination and Stool Examination (For Food Handlers)
Ishihara- Eye test (For Electrical Engineering, Computer Engineering, Electrical
Technology, Electronics Technology, and Automotive Technology.)
Chest Xray (For All courses)
Medical Certificate (For All courses)

However, due to the on-going COVID-19 pandemic, results of the above tests could not be
secured.

In view thereof, I hereby agree that as soon as the general condition shall have improved, I will
comply with the mentioned requirements. Should I fail in any of the tests, I hereby further agree to shift to
other courses/transfer to other BISU campuses subject to transfer guidelines.

I will not hold the university, or any of its personnel, liable for any consequence of this consent
that I herein declare.

Very Respectfully yours, Noted with Consent

______________________________________
Student’s signature over printed name ________________________________________
Parent’s signature over printed name

Subscribed and Sworn before me this ____ day of __________________________, 2020 at

_________________________________________________________ .

Doc No. _____________

Page No. _____________
Book No. _____________
Series of _____________
 Form No.: IFD-SP-PROC001-026
Revision No.: 00
BOHOL ISLAND STATE UNIVERSITY Effectivity Date: November 21, 2019
Zamora, Bilar, Bohol
Related
BISU-SP-PROC-001
Process:
STUDENT WAIVER

STUDENT WAIVER

Prepared by:

MARIA JULIET M. NAZARENO, MD

Medical Officer III

Noted by:

ERNESTO C. RULIDA, PhD MARIETTA C. MACALOLOT, PhD

Campus Director – Main Campus Director - Bilar

PROCESO M. CASTIL, EdD SAMUEL J. GULAYAN, PhD

Campus Director –Candijay Campus Director - Calape

DAISY V. DELLOSA,PhD PROF. VIRGILIA D. TEJADA

Campus Direcotor – Clarin Campus Director - Balilihan

Recommending Approval:

MARIA LILIBETH G. CASTIL, PhD

VP, Academic and Related Affairs

Approved by:

REGUCIVILLA A. POBAR, PhD

SUC President III