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  • Medical For Athletes 1

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    Lormy Layeka Calderon Siol
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    This medical certificate document contains a physical examination form to certify that a student is physically fit or unfit to participate in school sports competitions from intramural meets up to the national Palarong Pambansa games. The form includes checks for normal physical attributes and range of motion in different parts of the body. The student's name, age, sex, height, weight, and vital signs are recorded at each level of competition. The examining physician must sign after each evaluation.

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    Medical for Athletes 1

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    This medical certificate document contains a physical examination form to certify that a student is physically fit or unfit to participate in school sports competitions from intramural meets up to the national Palarong Pambansa games. The form includes checks for normal physical attributes and range of motion in different parts of the body. The student's name, age, sex, height, weight, and vital signs are recorded at each level of competition. The examining physician must sign after each evaluation.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    2 views2 pages

    Medical For Athletes 1

    Uploaded by

    Lormy Layeka Calderon Siol
    This medical certificate document contains a physical examination form to certify that a student is physically fit or unfit to participate in school sports competitions from intramural meets up to the national Palarong Pambansa games. The form includes checks for normal physical attributes and range of motion in different parts of the body. The student's name, age, sex, height, weight, and vital signs are recorded at each level of competition. The examining physician must sign after each evaluation.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Republic of the Philippines MCForm - 1

    Revised as of September 26,


    2019 DEPARTMENT OF EDUCATION

    ________________________
    (REGION)

    ______________________________
    (DIVISION)

    ______________________________
    (SCHOOL)

    M E D I______________________________
    CAL CERTIFICATE
    d. arms/hands YES | NO YES | NO YES | NO YES | NO
    To Whom It May Concern: e. hips YES | NO YES | NO YES | NO YES | NO
    f. thighs YES | NO YES | NO YES | NO YES | NO
    This is to certify that I have personally examined ___________________ g. knees YES | NO YES | NO YES | NO YES | NO
    Name h. ankles YES | NO YES | NO YES | NO YES | NO
    i. feet YES | NO YES | NO YES | NO YES | NO
    age ____ sex _____ and have found that he/she is physically fit unfit,
    11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
    during the time of examination, to join and participate in the lower meets up to (reflexes)
    Palarong Pambansa.
    Event: ___________________________ School/Intrams/District Meet Remarks/Findings:

    _____________________________ Ht ._______cm
    Physical Examination Physician/Medical Officer Wt:_______kg
    FIT
    (signature over printed name) BP.____________mmHg UNFIT
    School/ Unit/Division Regional Palarong PRC PR:____________bpm
    Intrams/District Meet Meet Pambansa LICENSE: PTR NO. RR:____________cpm
    Meet Date:
    Unit/Division Meet Remarks/Findings:
    Normal Normal Normal Normal
    1. Eyes YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT
    2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg
    3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm
    UNFIT
    4. Neck YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date:
    5. Cardiovascular YES | NO YES | NO YES | NO YES | NO Regional Meet Remarks/Findings:
    6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO
    7. Abdomen YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT
    Physician/Medical Officer Wt:_______kg
    8. Skin YES | NO YES | NO YES | NO YES | NO (signature over printed name) BP.____________mmHg UNFIT
    9. Genitalia-Hernia (male) YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm
    10. Muskuloskeletal: ROM YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date:
    a. neck YES | NO YES | NO YES | NO YES | NO Palarong Pambansa Remarks/Findings:
    b. spine YES | NO YES | NO YES | NO YES | NO
    _____________________________ Ht ._______cm FIT
    c. shoulder YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)


    Republic of the Philippines MCForm - 1

    DEPARTMENT OF EDUCATION

    ________________________
    (REGION)

    ______________________________
    (signature over printed name) BP.____________mmHg (DIVISION)
    PRC PR:____________bpm UNFIT
    LICENSE: PTR NO. RR:____________cpm ______________________________
    Date:
    (SCHOOL)

    ______________________________

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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