Marilao Saint Michael Family Hospital, Inc.

Address: C. Santiago, Marilao, 3019 Bulacan, Philippines

Phone: (044) 769 9012

Medical Certificate

I certify that I have carefully examined Mr./Ms. Stephanie B. Sapungay whose signature is given

below. Based on the examination, I certify that he/she is in good mental and physical health and is free

from physical defects which may interfere with his/ her work including the active outdoor duties

required.

Marks of Identification Dry Cough__________________

Signature of the Patient ___________________________

Date ___March 17, 2023_____________

Prepared by:
Arlen Bagongon Dr. Alfonso Victorino H. Famaran, MD,FPCS Medical Record / IT
Medical Officer