Republic of the Philippines

Department of Health
CENTRAL VISAYAS CENTER for HEALTH DEVELOPMENT
Osmeña Boulevard, Cebu City, Philippines 6000
Regional Director’s Office Tel. No (032) 253-6355 Fax No. (032) 254-0109
Official Website www.ro7.doh.gov.ph/Email Address dohro7@gmail.com

HEALTH EMERGENCY MANAGEMENT STAFF

Basic Life Support-Cardiopulmonary Resuscitation Training

MEDICAL CERTIFICATE

This is to certify that ____________________________, __________, _______________________

(Name) (Age) (Designation)

of the _________________________________________________________ is physically fit and –

1. has no heart and respiratory problems,

2. not on the “family way” or pregnant (female only), and

3. has no contagious disease.

________________________________________, M.D.
(Signature over printed name)

License No. ___________________________________

PTR No. ______________________________________

Date: ___________________________________, 2018