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  • DepEd Medical

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    Mariecriz Balaba Banaez
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    This document appears to be a health examination record form for Alma Lou B. Jala, a married female born in 1985 in Maco, Compostela Valley Province. The form includes sections to record information about her respiratory, circulatory, digestive, genitourinary, skin, locomotor, nervous, eyes/vision, ears, throat, nose, teeth, and immunization status. However, the form is incomplete as most sections contain blank lines instead of examination results. The physician's recommendation and remarks sections are also blank.

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    This document appears to be a health examination record form for Alma Lou B. Jala, a married female born in 1985 in Maco, Compostela Valley Province. The form includes sections to record information about her respiratory, circulatory, digestive, genitourinary, skin, locomotor, nervous, eyes/vision, ears, throat, nose, teeth, and immunization status. However, the form is incomplete as most sections contain blank lines instead of examination results. The physician's recommendation and remarks sections are also blank.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views1 page

    DepEd Medical

    Uploaded by

    Mariecriz Balaba Banaez
    This document appears to be a health examination record form for Alma Lou B. Jala, a married female born in 1985 in Maco, Compostela Valley Province. The form includes sections to record information about her respiratory, circulatory, digestive, genitourinary, skin, locomotor, nervous, eyes/vision, ears, throat, nose, teeth, and immunization status. However, the form is incomplete as most sections contain blank lines instead of examination results. The physician's recommendation and remarks sections are also blank.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Form No.

    86
    Republika ng Pilipinas
    KAGAWARAN NG EDUKASYON
    Rehiyon XI
    SANGAY NG DAVAO DE ORO
    MONKAYO WEST DISTRICT

    HEALTH EXAMINATION RECORD

    School: MONKAYO NATIONAL HIGH SCHOOL – SENIOR HIGH SCHOOL_____________________


    Name: ALMA LOU B. JALA__________________ Sex: FEMALE ___ Civil Status: MARRIED_____
    Date of Birth: DECEMBER 15, 1985________ Type of Work: __________________________________
    Place of Birth: MACO, COMPOSTELA VALLEY PROVINCE_______ Office: DepEd_______________

    1. Date: ______________ Age: ________ Height: _________ Weight: _________ BMI: _________
    2. Respiratory System:

    Fluorography Film No. ___________________ Date: _____________________


    Right Lung: ______________________ Left Lung: _____________________________
    Mediastinum: ______________________________________________________________
    Impression: ______________________________________________________________
    Recommendation: ________________________________________________________

    3. Circulatory System
    Blood Pressure ____________________mmHg
    Pulse Rate _______________________ Agility Test: After 3 mins: ___________________

    4. Digestive System: ______________________________________________________________


    5. Genito-Urinary System: ________________________________________________________
    6. Skin: __________________________________________________________________________
    7. Loco- motor System: ______________________________________________________________
    8. Nervous System: ______________________________________________________________
    9. Eyes, Conjuctiva etc. ______________________________________________________________
    10. Color Perception: ______________________________________________________________
    11. Vision with/without glasses: ________________________________________________________
    12. Ears: __________________________________________________________________________
    13. Throat:__________________________________________________________________________
    14. Nose: __________________________________________________________________________
    15. Teeth: __________________________________________________________________________
    16. Immunization: ____________________________________________________________________

    Remarks: __________________________________________________________________________
    Recommendation: ____________________________________________________________________
    Employee’s Signature: ________________________

    ________________________________
    Government Physician

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