This medical certificate is for Anthony John L. Julian, a 17-year old male student, to participate in lower level school sports competitions including intramurals, district, and regional meets up to the national Palarong Pambansa games. The physician conducted a full physical examination and found the student to be physically fit in all areas including eyes, ears, cardiovascular system, lungs, abdomen, skin, musculoskeletal system, and neuromuscular reflexes. The doctor certified the student as physically fit to participate in the listed lower level school sporting events.
This medical certificate is for Anthony John L. Julian, a 17-year old male student, to participate in lower level school sports competitions including intramurals, district, and regional meets up to the national Palarong Pambansa games. The physician conducted a full physical examination and found the student to be physically fit in all areas including eyes, ears, cardiovascular system, lungs, abdomen, skin, musculoskeletal system, and neuromuscular reflexes. The doctor certified the student as physically fit to participate in the listed lower level school sporting events.
This medical certificate is for Anthony John L. Julian, a 17-year old male student, to participate in lower level school sports competitions including intramurals, district, and regional meets up to the national Palarong Pambansa games. The physician conducted a full physical examination and found the student to be physically fit in all areas including eyes, ears, cardiovascular system, lungs, abdomen, skin, musculoskeletal system, and neuromuscular reflexes. The doctor certified the student as physically fit to participate in the listed lower level school sporting events.
DEPARTMENT OF EDUCATION REGION VI – WESTERN VISAYAS AKLAN NEW WASHINGTON NATIONAL COMPREHENSIVE HIGH SCHOOL Poblacion New Washington, Aklan
MEDICAL CERTIFICATE
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines MCForm - 1 DEPARTMENT OF EDUCATION REGION VI – WESTERN VISAYAS AKLAN NEW WASHINGTON NATIONAL COMPREHENSIVE HIGH SCHOOL School/Intrams/District Meet Remarks/Findings: Poblacion New Washington, Aklan To Whom It May Concern: _____________________________ Ht ._______cm FIT Physician/Medical Officer Wt:_______kg This is to certify that I have personally examined ANTHONY JOHN L. JULIAN (signature over printed name) BP.____________mmHg UNFIT Name PRC PR:____________bpm age 17 sex MALE and have found that he/she is physically fit unfit, LICENSE: PTR NO. RR:____________cpm Date: during the time of examination, to join and participate in the lower meets up to Unit/Division Meet Remarks/Findings:
Palarong Pambansa. _____________________________ Ht ._______cm FIT
Physician/Medical Officer Wt:_______kg (signature over printed name) BP.____________mmHg UNFIT PRC PR:____________bpm Event: TAEKWONDO 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)