UNIVERSITY OF THE PHILIPPINES

Diliman, Quezon City

HUMAN RESOURCES DEVELOPMENT OFFICE
Date
The Director
University Health Service
University of the Philippines
Quezon City
Dear Director :
This is to introduce a
prospective employee/faculty in this University, hom e are referrin! to your office for
physical and medical e"amination# Position to $e filled
%&ri!inal/Permanent'#
Please notify this &ffice as to the result of the e"amination# %(orm )ttached'
*ery truly yours,
(or the Director:
INSTRUCTION FOR PRE-EPLOYENT!PER"NENCY!PHYSIC"L!EDIC"L
E#"IN"TION
To facilitate the completion of your physical and medical e"amination, $e
sure to su$mit as early as possi$le to the University Health Service the folloin!:
+# (resh specimen of
a' Urine
$' (eces
,# ) certification of the last -.ray you had, if any#
/# 0edical (ee %(or ori!inal/reappointment only'#
CS FOR NO$ %&& '&(()* PHILIPPINE CIVIL SERVICE
01D2C)3 C14T2(2C)T1
(or employment
INS T RU C T IO N S
+# This medical certificate should $e accomplished $y a !overnment physician#
,# )ttach this certificate to ori!inal appointments and reinstatements#
FOR THE PROPOSED "PPOINTEE
5)01: %3ast, (irst, 0iddle or if 0arried oman 0aiden
5ame'
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)DD41SS
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P+e-Em,loyment e-i.al-P/y0i.al Te0t0
+# 8lood test
,# Urinalysis
/# Chest -.4ay
9# Dru! Test
:# 5euro Psychiatric 1"amination %2f necessary'
NOTE1 "LL RESULTS OF E#"IN"TIONS UST 2E "TT"CHED TO THIS FOR
FOR THE PHYSICI"N
2 here$y certify that 2 have personally e"amined the a$ovenamed
individual and found her/him to $e physically and mentally fit/unfit for
employment#
"FFI#
Documentary
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