Republic of the Philippines

Province of Southern Leyte

City of Maasin
Office of the City Health Services

MEDICAL CERTIFICATE
_________________ Date

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY THAT MR. /MRS._______________________________________________ AGE ______OF

BARANGAY____________________________________, MAASIN CITY WAS (PHYSICALLY TREATED, NOT TREATED) IN
THIS CLINIC / FACILITY ON _____________________________.

FINDINGS/DIAGNOSIS: BP:________________WT:______________T:

REMARKS: This issued upon the request for whatever legal purpose this may serve.

APRIL GERVIE B. MACABUHAY,MD,MPM-HSD

MEDICAL OFFICER III