ALTA RESOURCES (PHILIPPINES) CORP.

PRE-EMPLOYMENT PHYSICAL EXAMINATION SCHEDULE FORM

April 12, 2023

Date Issued:____________________ Valid Until:____________________
Ashley C. Cortez
Name:_________________________ 22
Age: _____Sex: [ ] Male [ ] Female

Pre-EMPLOYMENT PROCEDURES:
Complete Physical Examination
Complete Blood Count (CBC)
Urinalysis
Fecalysis
Chest x-ray

Important Reminders:
 This form may be presented to Aventus Clinics (please refer below for the address) together wi th any 2 valid government issued IDs.
 Urine specimen containers will be provided at the clinic. Kindly collect a mid -stream urine sample during the day of examination and
immediately submit to the laboratory. (Female can submit a specimen at least 7 days after the last day of menstruation)
 The patient should collect a pea sized stool specimen in the morning before proce eding to the clinic and must be submitted to the
Laboratory within 2 hours after collection
 A patient with prescription eyeglasses and/or contact lenses should bring the same during the examination for Visual Acuity.
 No fees will be collected from the patient. PPE costs are charged through Intellicare.
 All hard copy of PPE results should be forwarded to 34F Wynsum Corporate Plaza, 22F Ortigas Jr Road, Ortigas Center Pasig.

 Contact Person: Rhea Amor Juan / Glazelle Binanitan

 Repeat examination/clearances (i.e repeat urinalysis, pulmo clearance, cardio clearance) will be shouldered by the patient.

_______________________________ __________________________
Applicant’s signature Authorized HR Representative Signature
CLINIC COPY
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HR COPY
Confirmation of Pre-employment Examination ALTA RESOURCES (PHILIPPINES) CORP.
(Once the above examination is complete, detach this portion and submit it to HR/Recruitment)

PPE TESTS COMPLETED: YES

W ITH PENDING TEST/S: TO COME BACK ON:

Applicant’s printed name: Date: Time: 12:00 PM

Ashley C. Cortez April 12, 2023
Applicant’s signature: Aventus Signature of Nurse-on-duty:

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CLINIC ADDRESS:

AVENTUS ORTIGAS CLINIC

Unit 16, 18-20 Ground Floor AIC Grande Tower,
Sapphire road, Ortigas Center, Pasig City
Tel. # 584-2430, 570-9967
Clinic Hours for PPE: Mon-Sat. 8am-3pm (no lunch break)

AVENTUS MAKATI – FILOMENA BLDG.

6th floor Filomena Bldg. 104 Amorsolo Street
Legazpi Village Makati City
Tel: # 519-6787, 817-1464, 817-2715
Clinic Hours for PPE: Mon-Sat. 8am-3pm (no lunch break)

AVENTUS CLINIC-PCS
2/F Philippine College of Surgeons, Edsa,
Quezon City (beside SM North Annex)
Tel: 352-4676, 3524677, 455-1930
Clinic Hours for PPE: Mon-Sat. 8am-3pm (no lunch break)