This medical certificate from the Department of Education certifies that a student named Jeorge Nathan Custodio has been examined by a physician and found physically fit to participate in lower level school sports competitions like intramurals and district meets up to the Palarong Pambansa national games. The examination checked the student's eyes, ears, cardiovascular system, lungs, muscles and reflexes and found everything normal. The physician concluded the student is medically cleared to compete in volleyball for his school.
This medical certificate from the Department of Education certifies that a student named Jeorge Nathan Custodio has been examined by a physician and found physically fit to participate in lower level school sports competitions like intramurals and district meets up to the Palarong Pambansa national games. The examination checked the student's eyes, ears, cardiovascular system, lungs, muscles and reflexes and found everything normal. The physician concluded the student is medically cleared to compete in volleyball for his school.
This medical certificate from the Department of Education certifies that a student named Jeorge Nathan Custodio has been examined by a physician and found physically fit to participate in lower level school sports competitions like intramurals and district meets up to the Palarong Pambansa national games. The examination checked the student's eyes, ears, cardiovascular system, lungs, muscles and reflexes and found everything normal. The physician concluded the student is medically cleared to compete in volleyball for his school.
Revised as of September 26, 2019 DEPARTMENT OF EDUCATION
__________III____________ (REGION) _______NUEVA ECIJA_____ (DIVISION) SAN ISIDRO CENTRAL (SCHOOL) VALLARTA ST. POBLACION SAN ISDRO NUEVA ECIJA (School Address)
MEDICAL CERTIFICATE
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines MCForm - 1 DEPARTMENT OF EDUCATION __________III____________ (REGION) _______NUEVA ECIJA_____ (DIVISION) School/Intrams/District Meet Remarks/Findings: To Whom It May Concern: SAN ISIDRO CENTRAL (SCHOOL) _____________________________ Ht ._______cm FIT VALLARTA ST. POBLACION SAN ISDRO Physician/Medical NUEVA ECIJA Officer Wt:_______kg This is to certify that I have personally examined JEORGE NATHAN DC. (School Address) (signature over printed name) BP.____________mmHg UNFIT Name PRC PR:____________bpm CUSTODIO age___ sex MALE and have found that he/she is physically ___ fit LICENSE: PTR NO. RR:____________cpm Date: ___ unfit, during the time of examination, to join and participate in the lower meets Unit/Division Meet Remarks/Findings:
up to Palarong Pambansa. _____________________________ Ht ._______cm FIT
Physician/Medical Officer Wt:_______kg (signature over printed name) BP.____________mmHg UNFIT PRC PR:____________bpm Event: VOLLEYBALL E/G LICENSE: PTR NO. RR:____________cpm Date: Regional Meet Remarks/Findings: Physical Examination _____________________________ Ht ._______cm FIT School/ Unit/Division Regional Palarong Physician/Medical Officer Wt:_______kg Intrams/District Meet Meet Pambansa (signature over printed name) BP.____________mmHg UNFIT Meet PRC PR:____________bpm LICENSE: PTR NO. RR:____________cpm Date: Normal Normal Normal Normal Palarong Pambansa Remarks/Findings: 1. Eyes YES | NO YES | NO YES | NO YES | NO 2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT 3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg (signature over printed name) BP.____________mmHg UNFIT 4. Neck YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm 5. Cardiovascular YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date: 6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO 7. Abdomen YES | NO YES | NO YES | NO YES | NO 8. Skin YES | NO YES | NO YES | NO YES | NO 9. Genitalia-Hernia (male) YES | NO YES | NO YES | NO YES | NO 10. Muskuloskeletal: ROM YES | NO YES | NO YES | NO YES | NO a. neck YES | NO YES | NO YES | NO YES | NO b. spine YES | NO YES | NO YES | NO YES | NO c. shoulder YES | NO YES | NO YES | NO YES | NO d. arms/hands YES | NO YES | NO YES | NO YES | NO e. hips YES | NO YES | NO YES | NO YES | NO f. thighs YES | NO YES | NO YES | NO YES | NO g. knees YES | NO YES | NO YES | NO YES | NO h. ankles YES | NO YES | NO YES | NO YES | NO i. feet YES | NO YES | NO YES | NO YES | NO 11. Neuromuscular YES | NO YES | NO YES | NO YES | NO (reflexes)
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)