FORMNO. 211 (Revised August 1998) PHILIPPINE CIVIL SERVICE (MEDICAL CERTIFICATE ADMISSION INSTRUCTIONS: {This medical certificate should be accomplished by a government physioan 2.Altach this certificate to copies of medicaltental results STUDENT'S DATA NAVE (Cont Fist tidie, orf maned women, Maden Nome) femad, Saimen S$ ADDRESS Blk lo Lot 4, Mata lec a UL, noe Cok Gasymbaya Gen Sontes Ave. Lower Bitar, “Taguig city Student Medical-Physical Tests 1, Complete Blood Count (CBC) 2.Urinalyals 3.Chest X-ray 4. Focalyaie NOTE: ALL RESULTS OF EXAMINATIONS MUST BE ATTACHED TO THIS FORM. FOR THEPHYSICIAN Thereby certly that I have personally examined the above named Individual and found heehim, to be physical and medically FITAUNFTT for enroliment/to play. Nome: conan a ene Contact #: Contact Personin case of Emergency: athe Senay ecent: Signature of Nurse on Duty: