OSPITAL NG MUNTINLUPA

Sampaguita corner Macopa Sts., Pembo, Makati City

Tel. No. (02)868-0011

MEDICAL CERTIFICATE
Date: ___________________

TO WHOM IT MAY CONCERN:

This is to certify that __________________________________________________________________
Age ______________ years old, Sex:__________________ Civil Status: ________________________
Citizenship: _______________________ Occupation: __________________________ with address at
___________________________ was examined/treated/ confined in this hospital, from _____________
_______ for the following DIAGNOSIS:
1. Hematoma, Bottom Abdominal region, measuring 5x3.5inches
2. Hematoma, Lips region measuring 4.5x 3 cm right of the aml
3. Avulsed front tooth
Remarks:

This certification is beong issued for medical and legal purposes.

Erasures not honoured
THANK YOU
DRA. GEORGINA WILSON M.D.
Lic. No. 110111