Republic of the Philippines

Department of Education
Region VIII (Eastern Visayas)
DIVISION OF LEYTE
SAN MIGUEL District
San Miguel, Leyte

MEDICAL CERTIFICATE

April 17, 2023

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that I have personally examined MS. SHERLY G.

AVORQUE, 42 years old, female, born on December 11, 1980 and have
found that she is physically fit during the time of examination to
join and compete in the lower meets and 2023 Palarong Pambansa.

EVENT: GYMNASTICS
POSITION: Officiating Official
PHYSICAL EXAMINATION
Height: ___________ Weight: _____________ Blood Pressure ___________
Pulse Hearing: _________________ Respiratory Rate _______________
Other Remarks: ______________________________________________________
______________________________________________________
______________________________________________________

___________________________
Physician/Medical Officer
(Signature Over Printed Name)

License No. ______________

PTR: _______________
Date: _______________

FOR 2023 PALARONG PAMBANSA USE ONLY