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  • Pe Worksheet Revised

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    Ced Picones RCrim
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    This document is a doctor's worksheet for a medical examination. It contains fields to record a patient's name, age, sex, medical history, vital measurements like height, weight, blood pressure, and examination results for physical, eye, ear, and dental exams. The doctor will indicate if the patient is recommended or not recommended based on the examination and fill out their name and signature at the bottom.

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    This document is a doctor's worksheet for a medical examination. It contains fields to record a patient's name, age, sex, medical history, vital measurements like height, weight, blood pressure, and examination results for physical, eye, ear, and dental exams. The doctor will indicate if the patient is recommended or not recommended based on the examination and fill out their name and signature at the bottom.

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    © All Rights Reserved
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    3 views1 page

    Pe Worksheet Revised

    Uploaded by

    Ced Picones RCrim
    This document is a doctor's worksheet for a medical examination. It contains fields to record a patient's name, age, sex, medical history, vital measurements like height, weight, blood pressure, and examination results for physical, eye, ear, and dental exams. The doctor will indicate if the patient is recommended or not recommended based on the examination and fill out their name and signature at the bottom.

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    of 1

    1CY2023_2023_AADZWT

    PNP HS FORM NO. 2014-07


    2x2 colored picture with white
    background and the name should
    Republic of the Philippines appear below the picture
    National Police Commission
    PHILIPPINE NATIONAL POLICE (LAST, FIRST, M.I. & BELOW IS THE
    HEALTH SERVICE RANK).
    Camp PBGen Rafael T Crame, Quezon City

    CONTROL NO.__________________

    DOCTOR’S WORK SHEET


    NAME: CEDRICK PINEDA PICONES
    AGE/SEX:________________

    To be filled up by PE Section Medical Staff:

    EXAMINER’S CHECK
    STEPS DATE INITIAL
    FINDINGS/RESULT REMARKS IF OK

    MEDICAL HISTORY FORM

    MEASUREMENTS HEIGHT

    WEIGHT

    BMI

    WAIST CIRCUMFERENCE

    1ST 2ND 3RD


    BP

    1ST 2ND 3RD


    HEART RATE

    RESPIRATORY RATE

    GENERAL PHYSICAL EXAM

    GENERAL EYE EXAM

    VISUAL ACUITY

    COLOR VISION TEST (Ishihara)

    EAR EXAM

    ECG

    CHEST X-RAY

    DENTAL

    LABORATORY

    REVIEWED BY: RECOMMENDED / NOT RECOMMENDED

    _________________________________________________
    SIGNATURE OVER PRINTED NAME
    MEDICAL OFFICER

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