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DEPARTMENT OF EDUCATION
Region VI-Western Visayas
Division of San Carlos City
JULIO LEDESMA NATIONAL HIGH SCHOOL
J. V. Ledesma Avenue, Barangay Palampas, San Carlos City, Negros Occidental
MEDICAL CERTFICATE
Date: ____________________
Physical Examination
Date examined : __________________________
Height : ________ Weight : _________ Blood Pressure : _________
Pulse, Resting : ________ Respiratory Rate : _______________
Other Remarks : _______________________________________________________
This certification is issued upon the request of the above – mentioned name for
whatever legal purpose it may serve him/her best.
______________________________
Medical Officer
For Work Immersion Only