Republic of the Philippines

Department of Health
BUREAU OF HEALTH FACILITIES AND SERVICES

Month December Year 2020

MONTHLY STATISTICAL REPORT ON PRE-EMPLOYMENT MEDICAL EXAMINATION (PEME)

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Name of Clinic: ____MEDISENSE LABORATORY CENTER, INC. (MANILA)___________________________________________________________________________________
Address: 3rd& 4th FLR. BDO Bldg. T.M. Kalaw, Churucca St. Manila City Contact Nos.___5276349_____Fax No.__5276348___ E-mail Address__msl_overalllabincharge@yahoo.com__
Classification of Clinic (Please Check): Regular Land based and Sea based_________/________ Special Sea based_______________Special Land based____________________________
Instructions: fill out the tables properly and accurately. Put NA, if not applicable. Use additional sheets whenever necessary.

Table 1. Number of UNFIT PEME Certificates issued to LAND BASED work applicants and reasons for UNFITNESS

REASONS FOR UNFITNESS Number

HBsAg Reactive 48
TPHA 0
HIV 0
AHCV 8

TOTAL UNFIT 56

Total number of FIT PEME Certificates issued to land-based work applicants: _______________

Table 2. Number of UNFIT PEME Certificates Issued to SEAFARER Applicants and Reasons for UNFITNESS

REASONS FOR UNFITNESS Number

   
   
   
   
   
   
   
TOTAL UNFIT  

Total number of FIT PEME Certificates issued to seafarer applicants: ______________________

Prepared by: Juliet R. Manaois, RMT_ Validated by: George B. Baylosis, M.D.
Signature over Printed Name Medical Director
Chief Medical Technologist____ _ December 29 , 2020_
Designation Date