This medical certificate certifies that a student named _____________, age ___, sex _____, has been examined and found physically fit or unfit to participate in school sports events at different levels, from intramurals up to regional competitions. The student's physical examination results are documented for different areas of the body including eyes, ears, cardiovascular system, lungs, abdomen, skin, and musculoskeletal system. Examination findings for height, weight, blood pressure, pulse rate, and respiratory rate are also recorded for each level of competition.
This medical certificate certifies that a student named _____________, age ___, sex _____, has been examined and found physically fit or unfit to participate in school sports events at different levels, from intramurals up to regional competitions. The student's physical examination results are documented for different areas of the body including eyes, ears, cardiovascular system, lungs, abdomen, skin, and musculoskeletal system. Examination findings for height, weight, blood pressure, pulse rate, and respiratory rate are also recorded for each level of competition.
This medical certificate certifies that a student named _____________, age ___, sex _____, has been examined and found physically fit or unfit to participate in school sports events at different levels, from intramurals up to regional competitions. The student's physical examination results are documented for different areas of the body including eyes, ears, cardiovascular system, lungs, abdomen, skin, and musculoskeletal system. Examination findings for height, weight, blood pressure, pulse rate, and respiratory rate are also recorded for each level of competition.
Revised as of September 26, 2019 DEPARTMENT OF EDUCATION
2 (REGION) DIVISION OF NUEVA VIZCAYA (DIVISION) _________________________________________ (SCHOOL) _________________________________________ (School Address)
MEDICALCERTIFICATE
FOR SCHOOL SPORTS
Republic of the Philippines MCForm - 1 DEPARTMENT OF EDUCATION 2 (REGION) DIVISION OF NUEVA VIZCAYA (DIVISION) School/Intrams/District Meet Remarks/Findings: To Whom It May Concern: _________________________________________ (SCHOOL) _____________________________ Ht ._______cm FIT Physician/Medical Officer _________________________________________ Wt:_______kg This is to certify that I have personally examined ______________ age ___ (School Address) (signature over printed name) BP.____________mmHg UNFIT Name PRC PR:____________bpm sex ______ and have found that he/she is physically fit unfit, during LICENSE: PTR NO. RR:____________cpm Date: the time of examination, to join and participate in the lower meets up to Regional Unit/Division Meet Remarks/Findings:
Invitational Sporting Events( DepEd DOS RISE). _____________________________ Ht ._______cm FIT
Physician/Medical Officer Wt:_______kg (signature over printed name) BP.____________mmHg UNFIT PRC PR:____________bpm Event: ___________________________ LICENSE: PTR NO. RR:____________cpm Date: Regional Meet/DepED Dos RISE Remarks/Findings: Physical Examination _____________________________ Ht ._______cm FIT School/ Unit/Division DepED Dos Physician/Medical Officer Wt:_______kg Intrams/District Meet RISE (signature over printed name) BP.____________mmHg UNFIT Meet PRC PR:____________bpm LICENSE: PTR NO. RR:____________cpm Date: Normal Normal Normal Normal Palarong Pambansa Remarks/Findings: 1. Eyes YES | NO YES | NO YES | NO YES | NO 2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT 3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg (signature over printed name) BP.____________mmHg UNFIT 4. Neck YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm 5. Cardiovascular YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date: 6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO 7. Abdomen YES | NO YES | NO YES | NO YES | NO 8. Skin YES | NO YES | NO YES | NO YES | NO 9. Genitalia-Hernia (male) YES | NO YES | NO YES | NO YES | NO 10. Muskuloskeletal: ROM YES | NO YES | NO YES | NO YES | NO a. neck YES | NO YES | NO YES | NO YES | NO b. spine YES | NO YES | NO YES | NO YES | NO c. shoulder YES | NO YES | NO YES | NO YES | NO d. arms/hands YES | NO YES | NO YES | NO YES | NO e. hips YES | NO YES | NO YES | NO YES | NO f. thighs YES | NO YES | NO YES | NO YES | NO g. knees YES | NO YES | NO YES | NO YES | NO h. ankles YES | NO YES | NO YES | NO YES | NO i. feet YES | NO YES | NO YES | NO YES | NO 11. Neuromuscular YES | NO YES | NO YES | NO YES | NO (reflexes)