This medical certificate is for a student participating in school sports from lower meets up to the Palarong Pambansa (National Games). It certifies that the student, aged __, sex ___, from Cabanbanan National High School in Pangasinan, Philippines has been examined and found physically fit to participate. The certificate documents the results of the student's physical examination across multiple events and levels of competition, finding the student meets normal standards in areas like eyes, ears, cardiovascular system, and musculoskeletal range of motion. The examining physician signs with their name, PRC license number, and PTR number after each examination level.
This medical certificate is for a student participating in school sports from lower meets up to the Palarong Pambansa (National Games). It certifies that the student, aged __, sex ___, from Cabanbanan National High School in Pangasinan, Philippines has been examined and found physically fit to participate. The certificate documents the results of the student's physical examination across multiple events and levels of competition, finding the student meets normal standards in areas like eyes, ears, cardiovascular system, and musculoskeletal range of motion. The examining physician signs with their name, PRC license number, and PTR number after each examination level.
This medical certificate is for a student participating in school sports from lower meets up to the Palarong Pambansa (National Games). It certifies that the student, aged __, sex ___, from Cabanbanan National High School in Pangasinan, Philippines has been examined and found physically fit to participate. The certificate documents the results of the student's physical examination across multiple events and levels of competition, finding the student meets normal standards in areas like eyes, ears, cardiovascular system, and musculoskeletal range of motion. The examining physician signs with their name, PRC license number, and PTR number after each examination level.
Revised as of September 26, 2019 DEPARTMENT OF EDUCATION
_____________1___________ (REGION) _SCHOOLS DIVISION OFFICE PANGASINAN II _ (DIVISION) _CABANBANAN NATIONAL HIGH SCHOOL (SCHOOL) _CABANBANAN, MANAOAG, PANGASINAN (School Address)
MEDICAL CERTIFICATE
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines MCForm - 1 DEPARTMENT OF EDUCATION _____________1___________ (REGION) _SCHOOLS DIVISION OFFICE PANGASINAN II _ (DIVISION) School/Intrams/District Meet Remarks/Findings: To Whom It May Concern: _CABANBANAN NATIONAL HIGH SCHOOL (SCHOOL) _____________________________ Ht ._______cm FIT Physician/Medical Officer _CABANBANAN, MANAOAG, PANGASINAN 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 ___ sex _____ 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: TABLE TENNIS 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)