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  • Anadjah Ebrahim MC

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    Musaiden Ebrahim
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    Anadjah Ebrahim, age 20 from Quezon City, was examined on December 18, 2021 and found to be physically fit to enroll in educational activities but not fit to travel internationally. Laboratory tests including chest x-ray, CBC, urinalysis, and fecalysis were normal, and tests for HBsAg, anti-HBs, and pregnancy were non-reactive, reactive, and not applicable respectively. The patient's immunization record shows completed doses of hepatitis B, hepatitis A, influenza, typhoid, MMR, and varicella vaccines but pending doses of tetanus toxoid and Covid vaccine.

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    Anadjah Ebrahim, age 20 from Quezon City, was examined on December 18, 2021 and found to be physically fit to enroll in educational activities but not fit to travel internationally. Laboratory tests including chest x-ray, CBC, urinalysis, and fecalysis were normal, and tests for HBsAg, anti-HBs, and pregnancy were non-reactive, reactive, and not applicable respectively. The patient's immunization record shows completed doses of hepatitis B, hepatitis A, influenza, typhoid, MMR, and varicella vaccines but pending doses of tetanus toxoid and Covid vaccine.

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    12 views1 page

    Anadjah Ebrahim MC

    Uploaded by

    Musaiden Ebrahim
    Anadjah Ebrahim, age 20 from Quezon City, was examined on December 18, 2021 and found to be physically fit to enroll in educational activities but not fit to travel internationally. Laboratory tests including chest x-ray, CBC, urinalysis, and fecalysis were normal, and tests for HBsAg, anti-HBs, and pregnancy were non-reactive, reactive, and not applicable respectively. The patient's immunization record shows completed doses of hepatitis B, hepatitis A, influenza, typhoid, MMR, and varicella vaccines but pending doses of tetanus toxoid and Covid vaccine.

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    of 1

    HEALTH SERVICES

    MEDICAL CERTIFICATE

    Anadjah Ebrahim
    This is to certify that Mr./Ms. _________________________________, resident of

    Tatalon, Quezon City


    _____________________________________________, 20
    age __________, was seen and
    12-18-21
    examined by the undersigned on____________ is found to be:

    physically fit to: not fit to:

    enroll travel/ educ. tour (Local/ International)


    join contest/ team building attend seminar
    work undergo training (Local / International)
    others _________________

    Laboratory Results
    ____ Chest X-ray Normal
    Remarks: _____________________________________________
    ____ CBC Normal
    Remarks: _____________________________________________
    ____ Urinalysis Normal
    Remarks: _____________________________________________
    ____ Fecalysis Normal
    Remarks: _____________________________________________
    ____ HbsAg Non-reactive
    Remarks: _____________________________________________
    ____ Anti-HBs Reactive
    Remarks: _____________________________________________
    ____ Pregnancy Test Remarks: _____________________________________________
    ____ Drug Test Remarks: _________________________________________________

    Immunizations: _____Completed _____Pending


    Hepatitis B _____Dose 1 ____Dose 2 ____Dose 3
    Hepatitis A _____Dose 1 ____Dose 2
    Influenza _____Annual
    Typhoid _____Year 1
    MMR _____Dose 1 ____Dose 2
    Varicella _____Dose 1 ____booster
    Tetanus toxoid _____Dose 1
    Covid vaccine

    Vivian Marie M. Simon, MD


    Physician

    Not valid without seal


    FEU/E-HSE-QSF.11 Rev.No.: 01 Effectivity Date : 30 October2017

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