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CLINICA MEDICA

DELIKADO NA SERBISYO SA ABOT KAYANG PRESYO MEDICAL CLINIC

Contact: GLOBE: 0956-9851448 / SMART: 0960-5049278

MEDICAL CERTIFICATE

DATE: ____________

This is certify that Mr./Mrs. ________________________________________

____ yearls old, residing at __________________________________________________________

came in with a chief of complaint of ___________________________________________________

DIAGNOSIS

REMARKS

This is issued upon request and cannot be used for medicolegal pruposes.

Maria May S. Pelania, .D.


Lic No. 104787
PHYSICIAN

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