Republic of the Philippines

RAFAEL LAZATIN MEMORIAL MEDICAL CENTER

(Formerly Ospital Ning Angeles)
"PHIC Accredited Health Care Provider"
Visitacion Street corner Pampang Road
Angeles City, Phiippines 2009
Tel, Nos.: (045) 322-1222/ (045) 322-4495/ (045) 887-4133
Email add: ona_rlmmc@yahoo.com

MEDICAL CERTIFICATE

To Whom It May Concern:

This is to certify that

old,

residing at

Was examined in this hospital on

Because of

Diagnosis:

NOTE: FIT TO WORK.

Issued upon the request of

for purposes.

TRISTAN B. TULUD, MD

MED OFF V.

Lic.# 71864

Hospital Form No. 20

Hospital Form No. 20