This medical certificate certifies that a male student named [NAME] is physically fit to participate in lower level school sports competitions including arnis for secondary boys. The certificate documents the student's physical examination results across multiple body systems and joints, noting whether each was normal, for four levels of competition: school/intramural district meet, unit/division meet, regional meet, and Palarong Pambansa national meet. The physician's signature confirms the examination findings and fitness determination for each competition level.
This medical certificate certifies that a male student named [NAME] is physically fit to participate in lower level school sports competitions including arnis for secondary boys. The certificate documents the student's physical examination results across multiple body systems and joints, noting whether each was normal, for four levels of competition: school/intramural district meet, unit/division meet, regional meet, and Palarong Pambansa national meet. The physician's signature confirms the examination findings and fitness determination for each competition level.
This medical certificate certifies that a male student named [NAME] is physically fit to participate in lower level school sports competitions including arnis for secondary boys. The certificate documents the student's physical examination results across multiple body systems and joints, noting whether each was normal, for four levels of competition: school/intramural district meet, unit/division meet, regional meet, and Palarong Pambansa national meet. The physician's signature confirms the examination findings and fitness determination for each competition level.
Revised as of September 26, 2019 DEPARTMENT OF EDUCATION
XI (REGION) DAVAO DEL SUR (DIVISION)
B (School Address)
MEDICAL CERTIFICATE
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines MCForm - 1 DEPARTMENT OF EDUCATION XI (REGION) DAVAO DEL SUR (DIVISION) _____________________________ Ht ._______cm To Whom It May Concern: B Physician/Medical Officer Wt:_______kg FIT (School Address) (signature over printed name) BP.____________mmHg This is to certify that I have personally examined .____. age UNFIT PRC PR:____________bpm Name LICENSE: PTR NO. RR:____________cpm sex MALE and have found that he/she is physically fit unfit, during the Date: Unit/Division Meet Remarks/Findings: time of examination, to join and participate in the lower meets up to Palarong _____________________________ Ht ._______cm FIT Pambansa. Physician/Medical Officer Wt:_______kg (signature over printed name) BP.____________mmHg UNFIT PRC PR:____________bpm LICENSE: PTR NO. RR:____________cpm Date: Event: ARNIS – BOYS (SECONDARY) Regional Meet Remarks/Findings:
Physical Examination _____________________________ Ht ._______cm FIT
Physician/Medical Officer Wt:_______kg School/ Unit/Division Regional Palarong (signature over printed name) BP.____________mmHg UNFIT Intrams/District Meet Meet Pambansa PRC PR:____________bpm Meet LICENSE: PTR NO. RR:____________cpm Date: Normal Normal Normal Normal Palarong Pambansa Remarks/Findings: 1. Eyes YES | NO YES | NO YES | NO YES | NO 2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT Physician/Medical Officer Wt:_______kg 3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO (signature over printed name) BP.____________mmHg UNFIT 4. Neck YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm 5. Cardiovascular YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date: 6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO 7. Abdomen YES | NO YES | NO YES | NO YES | NO 8. Skin YES | NO YES | NO YES | NO YES | NO 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)
School/Intrams/District Meet Remarks/Findings:
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)