Republic of the Philippines

Department of Education
Region VII, Central Visayas
DIVISION OF TALISAY CITY
J.P. Rizal St., Poblacion, City of Talisay, Cebu
Email: talisaycity.division@deped.gov.ph
Facebook Page: Deped Talisay

PHYSICAL EXAMINATIONS

Date Examined: ______________________________

Height : __________

Weight : __________

Blood Pressure : __________

Pulse, Resting : __________

Respiratory Rate : __________

Other Remarks:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

MEDICAL CERTIFICATE

This is to certify that I have personally examined ______________________________,

__________ years old and born on ______________________________, who is found
physically fit, during the time of examination, to participate in the 2022 Regional Schools Press
Conference with the theme, Empowering Resilient Communities through Campus Journalism,
via Flexible Delivery Modality on May 17-20, 2022 with the Regional Office as the host.

Given this __________ day of May, 2022 at ______________________________,

Talisay City, Cebu.

________________________________________
Signature over Printed Name of the
Physician/Medical Officer

mrm
5/3/2022

“EFA 2015: Karapatan ng Lahat, Pananagutan ng Lahat!”

SDS (Telefax): 491-3798, 491-5593; ASDS: 491-3795; CID: 491-3793; SGOD: 491-3796; Admin: 491-3797; Finance: 491-3799; ICT: 491-3794