2 ass RCRAY & LABORATORY SERVICES NATIONAL ROAD, BAYANAN, MUNTINLUPA CITY ‘Tel No. 0919-500-9254 ‘Accredited Li No. 134303-16-CL-2 EMPLOYER: Local Baployment JOB APPLIED FOR: as —— = | AGE a) ype old SEX Cae Brome ‘CIviL STATUS: gglomout Cine ADDRESS. Streot JPA SUBDe 38 ds HEIGHT: _4*9" DISTINGUISHING MARK: WEIGHT: DATE EXAMINATION: ainN THAT I HAVE EXAMINED AND g 1 CEROUND, THE APPLICANT TO BE ee seuarcatty ray iNeTED FOR L oO SIGNATURE DF APPLICANT MP CERTIFICATION AND/ OR RECOMMENDATION: . [ o ctassA co crass B D ciassC_| 0 CLASS ee na [riety iecemparend | ain arecrtetme namely camel “ea nee 7emeet | eoplerment berm m2 wor | Comte, Dy seiner tt inition De rwst cote min dee > | ROMEO L. CANATOY, MD OMEO sedical Examiner 99255. ———— SS eee ‘ Note This cari Tie cece dan ont cne wi a Se fot nsdn at ous sie cru a ei ny esos Tag ERE et ah an ee ere=o HESS PRESENT SYMTOMS SIGNIFICANT PAST DISEASES | OPERATION pee, {Rone NONE IF THERE 15 ‘IF THERE 1S (IF THERE IS ‘STATE ‘STATE sare <4. Forstnare 391021 wooo rasssune CO [Qa wercern SE 4 wncnr. sf Ne FAR VISION "NEAR VISION ‘With yeglesses R207 ‘With Byeglasses RT fo x _Miihed Byegines RE tL Fou sunokess: ()¥es (NO HEARING [)NORMAL (DEFECTIVE REVEEWOFSYSTEMS FINDINGS NORMAL | ABNORMAL FINDINGS) REMARKS Shin Head Ne, Seip : é es, External Ei s Pol, Optalnosopie 5 ae “ Ne Sa Moat Trost Tonge s . Denil (ees 4 eck, gh Nae TT : Chen Breast Als S & one ack ae 2 OME Xp Blueptes ROENCENOLOGICAL REPORT Grea ray No nate PAPE Dy TI cara () arIco-LonDOTIC REVIEW (G3 ESSENTIAL NEGATIVE CHEST A ausenro c. Aacanaic SIGNIFICANT FINDINGS: tage fs _MDFPCR Radiologist {CERTIFY THAT I AM THE SAME PERSON BEING MEDICALY EXAMINED WHOSE NAME AND SIGNATURE APFARS ON THE MEDICAL RECOKO AND I HAVE TRUTHFULLY ANSWERED THE [QUESTIONS ASKED REGARDING MY WELL-BEING. HNDINGS ‘Complete tiood CourtX-RAY & LABORATORY SERVICES 235 NATIONAL ROAD, BAYANAN, MUNTINLUPA CITY 2 BAYANAN MEDICAL CLINIC Ta, No. 0919-00.9234 Accredited Li. Nos NOR MS62.18 DaTE___3/30/19 Roentgenological Report X-RAYNO___3618 a NAME _ Ramos, Jerlah Kate dee set ae’ WER Paes EXAMINATION DONE Teast REFERRED BY? Both Lungs clear, Heartis not enlarged Diaphragm and sinuses are normal Bony thorax intact Evaluation: Normal Chest Fim 'ARAIG M.D., FPCR Sighatufe Rx RADIOLOGIST