Revised as of February 2024

MEDICAL CERTIFICATE
(COACHES, ASSISTANT COACHES, CHAPERONE)

FEBRUARY 15,2024
(Date)
To Whom It May Concern:

This is to certify that I have personally examined __ MARIA CORAZON M. SABIO

_ age _ 53 yrs. old sex Female and have found that he/she is physically

__/__fit _____unfit, during the time of examination, to join and participate in the lower

meets up to Palarong Pambansa.

Event:_____TENNIS ELEMENTARY______

Physical Examination

School/Intrams/District Meet Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg

FIT
Physician/Medical Officer
BP.____________mmHg
(signature over printed name)
UNFIT
PRC PR:____________bpm
LICENSE: PTR NO.
RR:____________cpm Date:

Unit/Division Meet Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg

FIT
Physician/Medical Officer
BP.____________mmHg
(signature over printed name)
UNFIT
PRC PR:____________bpm
LICENSE: PTR NO.
RR:____________cpm Date:
Regional Meet Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg

FIT
Physician/Medical Officer
BP.____________mmHg
(signature over printed name)
UNFIT
PRC PR:____________bpm
LICENSE: PTR NO.
RR:____________cpm Date:

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Palarong Pambansa Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg

FIT
Physician/Medical Officer
BP.____________mmHg
(signature over printed name)
UNFIT
PRC PR:____________bpm
LICENSE: PTR NO.
RR:____________cpm Date:

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)