Mapagu Medical Clinic: 2/F Room 202 Synita Bldg. Kayang Street Baguio City, Philippines 2600

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MAPAGU MEDICAL CLINIC

2/F ROOM 202 SYNITA BLDG. KAYANG STREET


BAGUIO CITY, PHILIPPINES 2600

HOSPITAL AFFILIATIONS:
Pines City Doctors Hospital, SLU Hospital of the Sacred Heart, Notre Dame de Chartes Hospital
Benguet General Hospital, Baguio Medical Center

DATE:_______________________

MEDICAL CERIFICATE

To Whom It May Concern:

This is to certify that__________________________________________________________________________


___________ years old, sought consultation / was admitted for _______________________________________________
__________________________________________________________________________________________________
On ______________________________________________.

DIAGNOSIS:______________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

TREATMENT/RECOMMENDATION:_________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

NOTE: This certificate is issued for ______________________________________________ONLY.

BY:_______________________
LICENSE #: 75684
PTR NO. 2296969

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