Scribd Logo
Upload

Welcome to Scribd!

  • CSC Form 86

    Uploaded by

    brigette
    6 views3 pages
    This document is a health examination form for Johnny M. Compelio, a 49-year-old male nurse working at Abatan Elementary School in Buguias, Benguet, Cordillera Administrative Region, Philippines. It includes personal information like birthdate, height, weight, and occupation. The physical examination section is blank, awaiting the physician's assessment, notes, diagnosis, and treatment plan. The form is signed by both the employee and examining physician.

    Original Description:

    For Annual Medical

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a health examination form for Johnny M. Compelio, a 49-year-old male nurse working at Abatan Elementary School in Buguias, Benguet, Cordillera Administrative Region, Philippines. It includes personal information like birthdate, height, weight, and occupation. The physical examination section is blank, awaiting the physician's assessment, notes, diagnosis, and treatment plan. The form is signed by both the employee and examining physician.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views3 pages

    CSC Form 86

    Uploaded by

    brigette
    This document is a health examination form for Johnny M. Compelio, a 49-year-old male nurse working at Abatan Elementary School in Buguias, Benguet, Cordillera Administrative Region, Philippines. It includes personal information like birthdate, height, weight, and occupation. The physical examination section is blank, awaiting the physician's assessment, notes, diagnosis, and treatment plan. The form is signed by both the employee and examining physician.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    CSC Form 86

    Republic of the Philippines


    Department of Education
    Cordillera Administrative Region
    HEALTH AND NUTRITION SECTION

    Division: BENGUET District: BUGUIAS

    Name: _____________________________ Maiden Name if Married: ____________________

    Date of Birth: _________________________ Place of Birth: _____________________________

    Civil Status: ______ Occupation: _____________ Status of Appointment: ________________

    School: __________________________________________________________________________

    Age: _____ Sex: _____ Height: ______ Weight: ______ BMI: _______ NS: ______

    Past History: _____________________________________________________________________

    PHYSICAL EXAMINATION:
    Temperature: _________ Blood Pressure: _______ mm/hg Pulse Rate: ________

    Skin: ___________________________________________________________________________

    EENT: __________________________________________________________________________

    Heart: __________________________________________________________________________

    Lungs: _________________________________________________________________________

    Abdomen: ______________________________________________________________________

    Extremities: _____________________________________________________________________

    Genito-Urinary Tract: _____________________________________________________________

    Central Nervous System: __________________________________________________________

    Laboratory Test Results: ___________________________________________________________

    Diagnosis: ______________________________________________________________________

    Treatment: _____________________________________________________________________

    Remarks: _______________________________________________________________________

    Employee’s Signature: __________________

    Physician’s Signature: __________________________________


    Date Examined: _______________________________________
    CSC Form 86
    Republic of the Philippines
    Department of Education
    Cordillera Administrative Region
    HEALTH AND NUTRITION SECTION

    Division: BENGUET District: BUGUIAS

    Name: JOHNNY M. COMPELIO Maiden Name if Married: ____________________

    Date of Birth: SEPTEMBER 6, 1969 Place of Birth: BAKUN, BENGUET

    Civil Status: MARRIED Occupation: NURSING Status of Appointment: PERMANENT

    School: ABATAN ELEMENTARY SCHOOL

    Age: 49 Sex: MALE Height: 157cm Weight: 68kg BMI: 27.58 NS: OW

    Past History: _____________________________________________________________________

    PHYSICAL EDUCATION:
    Temperature: _________ Blood Pressure: _______ mm/hg Pulse Rate: ________

    Skin: ___________________________________________________________________________

    EENT: __________________________________________________________________________

    Heart: __________________________________________________________________________

    Lungs: _________________________________________________________________________

    Abdomen: ______________________________________________________________________

    Extremities: _____________________________________________________________________

    Genito-Urinary Tract: _____________________________________________________________

    Central Nervous System: __________________________________________________________

    Laboratory Test Results: ___________________________________________________________

    Diagnosis: ______________________________________________________________________

    Treatment: _____________________________________________________________________

    Remarks: _______________________________________________________________________

    Employee’s Signature: __________________

    Physician’s Signature: _____________________________


    Date Examined: _______________________________________

    You might also like