Republic of the Philippines

Province of Tarlac
MUNICIPALITY OF GERONA
Document Code:
Quality Form for LGUGERONA-QF-XXX-001

QMS and ISO 9001:2015 Revision: 00

Effectivity date: 09-30-2019

MEDICAL Name of Office:

MUNICIPAL HEALTH
CERTIFICATE RURAL HELTH UNIT
GERONA TTMF

Control No.: MHO RHU-1 2021

To whom it May Concern

This is to certify that

NAME : MARIE NEL M. OHOYLAN

ADDRESS : ABAGON GERONA, TARLAC
AGE : 23 Y/O
SEX : FEMALE
BIRTH DATE : SEPTEMBER 21, 1998
CIVIL STATUS : SINGLE
DATE CONFIRMED : SEPTEMBER 09, 2921
DATE ADMSSION : SEPTEMBER 09, 2021
DATE OF DISCHARGE : SEPTEMBER 23, 2921
Was seen examined and treated by the undersigned on September 24, 2021.
This verification is issued for all intents and purposes.

DIAGNOSIS: COVID 19-CONFIRMED MILD CLINICALLY RECOVERED.

RECOMMENDATIONS: COMPLETED 14 DAYS HOME QUARANTINE.

RECOVERED

DR.JULIET OFIANA-CABUNOC
Municipal Health Officer
License No. 070838
 Republic of the Philippines
Province of Tarlac
MUNICIPALITY OF GERONA
Document Code:
Quality Form for LGUGERONA-QF-XXX-001

QMS and ISO 9001:2015 Revision: 00

Effectivity date: 09-30-2019

MEDICAL Name of Office:

MUNICIPAL HEALTH
CERTIFICATE RURAL HELTH UNIT
GERONA TTMF

Control No.: MHO RHU-1 2021

(Date)

To Whom It May Concern:

THIS IS CERTIFY that Mr, / Miss _______________________________________

Of __________________________________________.

Was examined and treated at the Muncipal Health Office on ________________,20

_____ with the following was found out to be in good health and is physically and mentally
fit to work.

This medical certificate is issued per request of the above-named patient.

DR.JULIET OFIANA-CABUNOC
Municipal Health Officer
Licence No. 070838