This medical certificate finds a 12-year-old male student physically fit to participate in lower level school sports competitions like arnis up to the Palarong Pambansa national games. The doctor conducted a full physical examination checking the student's eyes, ears, mouth, neck, heart, lungs, skin, joints and reflexes and found everything normal. The form documents the examination results at each level of competition from intramural to district to regional meets up to the national Palarong Pambansa.
This medical certificate finds a 12-year-old male student physically fit to participate in lower level school sports competitions like arnis up to the Palarong Pambansa national games. The doctor conducted a full physical examination checking the student's eyes, ears, mouth, neck, heart, lungs, skin, joints and reflexes and found everything normal. The form documents the examination results at each level of competition from intramural to district to regional meets up to the national Palarong Pambansa.
This medical certificate finds a 12-year-old male student physically fit to participate in lower level school sports competitions like arnis up to the Palarong Pambansa national games. The doctor conducted a full physical examination checking the student's eyes, ears, mouth, neck, heart, lungs, skin, joints and reflexes and found everything normal. The form documents the examination results at each level of competition from intramural to district to regional meets up to the national Palarong Pambansa.
Revised as of September 26, 2019 DEPARTMENT OF EDUCATION
ZAMBOANGA PENINSULA (REGION) ZAMBOANGA DEL SUR (DIVISION) COMMONWEALTH ELEMENTARY SCHOOL (SCHOOL) COMMONWEALTH, AURORA ZDS (School Address)
MEDICAL CERTIFICATE
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines MCForm - 1 DEPARTMENT OF EDUCATION ZAMBOANGA PENINSULA (REGION) ZAMBOANGA DEL SUR (DIVISION) School/Intrams/District Meet Remarks/Findings: To Whom It May Concern: COMMONWEALTH ELEMENTARY SCHOOL (SCHOOL) _____________________________ Ht ._______cm FIT COMMONWEALTH, AURORA ZDS Physician/Medical Officer Wt:_______kg This is to certify that I have personally examined JHOMAR B. VALLASO age 12(School sex Address) (signature over printed name) BP.____________mmHg UNFIT Name PRC PR:____________bpm MALE and have found that he/she is physically fit unfit, during the time of LICENSE: PTR NO. RR:____________cpm Date: examination, to join and participate in the lower meets up to Palarong Pambansa. Unit/Division Meet Remarks/Findings:
Event: ARNIS ELEMENTARY BOYS _____________________________ Ht ._______cm FIT
Physician/Medical Officer Wt:_______kg Physical Examination (signature over printed name) BP.____________mmHg UNFIT PRC PR:____________bpm School/ Unit/Division Regional Palarong LICENSE: PTR NO. RR:____________cpm Date: Intrams/District Meet Meet Pambansa Regional Meet Remarks/Findings: Meet Normal Normal Normal Normal _____________________________ Ht ._______cm FIT Physician/Medical Officer Wt:_______kg 1. Eyes YES | NO YES | NO YES | NO YES | NO (signature over printed name) BP.____________mmHg UNFIT 2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm LICENSE: PTR NO. RR:____________cpm Date: 3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO Palarong Pambansa Remarks/Findings: 4. Neck YES | NO YES | NO YES | NO YES | NO 5. Cardiovascular YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT 6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg 7. Abdomen YES | NO YES | NO YES | NO YES | NO (signature over printed name) BP.____________mmHg UNFIT PRC PR:____________bpm 8. Skin YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date: 9. Genitalia-Hernia (male) YES | NO YES | NO YES | NO YES | NO 10. Muskuloskeletal: ROM YES | NO YES | NO YES | NO YES | NO a. neck YES | NO YES | NO YES | NO YES | NO b. spine YES | NO YES | NO YES | NO YES | NO c. shoulder YES | NO YES | NO YES | NO YES | NO d. arms/hands YES | NO YES | NO YES | NO YES | NO e. hips YES | NO YES | NO YES | NO YES | NO f. thighs YES | NO YES | NO YES | NO YES | NO g. knees YES | NO YES | NO YES | NO YES | NO h. ankles YES | NO YES | NO YES | NO YES | NO i. feet YES | NO YES | NO YES | NO YES | NO 11. Neuromuscular YES | NO YES | NO YES | NO YES | NO (reflexes)
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)