This document is a medical certificate for a student named Jaymie A. Buenaventura assessing her fitness to participate in school sports competitions from lower meets up to the Palarong Pambansa national games. It was issued by a physician and contains the results of a physical examination finding her physically fit in all areas assessed. The examination checked 11 body systems and regions including eyes, ears, cardiovascular system, lungs, muscles and reflexes. The physician certified she is medically cleared to compete.
This document is a medical certificate for a student named Jaymie A. Buenaventura assessing her fitness to participate in school sports competitions from lower meets up to the Palarong Pambansa national games. It was issued by a physician and contains the results of a physical examination finding her physically fit in all areas assessed. The examination checked 11 body systems and regions including eyes, ears, cardiovascular system, lungs, muscles and reflexes. The physician certified she is medically cleared to compete.
This document is a medical certificate for a student named Jaymie A. Buenaventura assessing her fitness to participate in school sports competitions from lower meets up to the Palarong Pambansa national games. It was issued by a physician and contains the results of a physical examination finding her physically fit in all areas assessed. The examination checked 11 body systems and regions including eyes, ears, cardiovascular system, lungs, muscles and reflexes. The physician certified she is medically cleared to compete.
Revised as of September 26, 2019 DEPARTMENT OF EDUCATION
__________III____________ (REGION) _______NUEVA ECIJA_____ (DIVISION) PULO NATIONAL HIGH SCHOOL (SCHOOL) PULO, SAN ISIDRO, NUEVA ECIJA (School Address)
MEDICAL CERTIFICATE
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines MCForm - 1 DEPARTMENT OF EDUCATION __________III____________ (REGION) _______NUEVA ECIJA_____ (DIVISION) School/Intrams/District Meet Remarks/Findings: To Whom It May Concern: PULO NATIONAL HIGH SCHOOL (SCHOOL) _____________________________ Ht ._______cm FIT PULO, SAN ISIDRO, NUEVA Physician/Medical ECIJA Officer Wt:_______kg This is to certify that I have personally examined JAYMIE A. (School Address) (signature over printed name) BP.____________mmHg UNFIT Name PRC PR:____________bpm BUENAVENTURA age 16 sex FEMALE and have found that he/she is physically LICENSE: PTR NO. RR:____________cpm Date: ___ fit ___ unfit, during the time of examination, to join and participate in the Unit/Division Meet Remarks/Findings:
lower meets up to Palarong Pambansa. _____________________________ Ht ._______cm FIT
Physician/Medical Officer Wt:_______kg (signature over printed name) BP.____________mmHg UNFIT PRC PR:____________bpm Event: BILLIARDS 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)