This medical certificate certifies that a 15-year-old male student named Eldridge Xian T. Cabungcal from Consuelo National High School in Misamis Oriental, Philippines has been examined and found physically fit to participate in lower level school sports competitions like intramurals up to the national Palarong Pambansa games. The physician conducted a full physical examination checking the student's eyes, ears, cardiovascular system, lungs, muscles and reflexes and found everything to be normal.
This medical certificate certifies that a 15-year-old male student named Eldridge Xian T. Cabungcal from Consuelo National High School in Misamis Oriental, Philippines has been examined and found physically fit to participate in lower level school sports competitions like intramurals up to the national Palarong Pambansa games. The physician conducted a full physical examination checking the student's eyes, ears, cardiovascular system, lungs, muscles and reflexes and found everything to be normal.
This medical certificate certifies that a 15-year-old male student named Eldridge Xian T. Cabungcal from Consuelo National High School in Misamis Oriental, Philippines has been examined and found physically fit to participate in lower level school sports competitions like intramurals up to the national Palarong Pambansa games. The physician conducted a full physical examination checking the student's eyes, ears, cardiovascular system, lungs, muscles and reflexes and found everything to be normal.
Revised as of September 26, 2019 DEPARTMENT OF EDUCATION
X (REGION) MISAMIS ORIENTAL (DIVISION) CONSUELO NATIONAL HIGH SCHOOL (SCHOOL) BRGY. CONSUELO, MAGSAYSAY, MISAMIS ORIENTAL (School Address)
MEDICAL CERTIFICATE
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines MCForm - 1 DEPARTMENT OF EDUCATION X (REGION) MISAMIS ORIENTAL (DIVISION) School/Intrams/District Meet Remarks/Findings: To Whom It May Concern: CONSUELO NATIONAL HIGH SCHOOL (SCHOOL) _____________________________ Ht ._______cm FIT BRGY. ELDRIDGE XIANCONSUELO, T. Physician/Medical MAGSAYSAY, MISAMIS CABUNGCAL ORIENTAL Officer Wt:_______kg This is to certify that I have personally examined _____________________ (School Address) (signature over printed name) BP.____________mmHg UNFIT Name PRC PR:____________bpm age _15_ 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: BASKETBALL 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)