Republic of the Philippines

City of Cebu
CEBU DOCTORS’ UNIVERSITY HOSPITAL

To Whom It May Concern: MEDICAL OPD # 43-23-45

This is to certify that as per record of this hospital, Miss HYORI

A. KAINE, 27 years old, Single, Filipino, resident of Gov. Cuenco
Ave, Banilad, Cebu City, has undergone a thorough medical
examination conducted at Cebu Doctors’ University Hospital on
December 10, 2018 by Dr. Shin D. Reila and currently suffering from
a second degree abrasion on the scalp located at the top of the head
caused by sudden pulled out of hair, on the right elbow and left hand
and contusions on the left arm. It needs to be medically attended for
a period of one to nine days and will incapacitate her from labor for
some period of time.

____SHIN D. REILA, M.D.___

Attending Physician

This certificate is issued upon the request of the Patient/Relative

whose signature is shown below.

___HYORI A. KAINE___
Patient/Relative
(Signature over Printed Name)

Prepared By:_ SHIN D. REILA, M.D._

Date :___________________