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  • Medical Certificate: Physical Examination

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    mark Dee
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    This medical certificate finds Jonathan S. Humpa, age 32 and male, physically fit to participate in lower level athletic competitions up to the Palarong Pambansa national games. The doctor conducted a full physical examination checking eyes, ears, mouth, neck, heart, lungs, abdomen, skin, genitals, range of motion, and neuromuscular reflexes. The examination was documented for intramural, district, regional and national level events and the doctor certified him as physically fit for each level of competition based on normal findings of height, weight, blood pressure, pulse and respiration rate.

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    Certificate m

    Original Title

    M-E-D-I-C-A-L-C-E-R-T-I-F-I-C-A-T-E

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    This medical certificate finds Jonathan S. Humpa, age 32 and male, physically fit to participate in lower level athletic competitions up to the Palarong Pambansa national games. The doctor conducted a full physical examination checking eyes, ears, mouth, neck, heart, lungs, abdomen, skin, genitals, range of motion, and neuromuscular reflexes. The examination was documented for intramural, district, regional and national level events and the doctor certified him as physically fit for each level of competition based on normal findings of height, weight, blood pressure, pulse and respiration rate.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    7 views2 pages

    Medical Certificate: Physical Examination

    Uploaded by

    mark Dee
    This medical certificate finds Jonathan S. Humpa, age 32 and male, physically fit to participate in lower level athletic competitions up to the Palarong Pambansa national games. The doctor conducted a full physical examination checking eyes, ears, mouth, neck, heart, lungs, abdomen, skin, genitals, range of motion, and neuromuscular reflexes. The examination was documented for intramural, district, regional and national level events and the doctor certified him as physically fit for each level of competition based on normal findings of height, weight, blood pressure, pulse and respiration rate.

    Copyright:

    © All Rights Reserved
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    Revised as of September 26, 2019 Republic of the Philippines MCForm - 1

    DEPARTMENT OF EDUCATION
    Region IX, Zamboanga Peninsula
    Division of Zamboanga del Sur
    District of Lapuyan
    Lapuyan, Zamboanga del Sur

    MEDICAL CERTIFICATE
    To Whom It May Concern:

    This is to certify that I have personally examined JONATHAN S. HUMPA age sex 32 and male
    have found that he/she is
    physically fit unfit, during the time of examination, to join and participate in the lower meets up to Palarong Pambansa.
    Event: ___________________________
    Physical Examination
    School/ Unit/Division Regional Palarong
    Intrams/District Meet Meet Pambansa
    Meet
    Normal Normal Normal Normal
    1. Eyes YES | NO YES | NO YES | NO YES | NO
    2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO
    3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO
    4. Neck YES | NO YES | NO YES | NO YES | NO
    5. Cardiovascular YES | NO YES | NO YES | NO YES | NO
    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)

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)


    Republic of the Philippines MCForm - 1
    DEPARTMENT OF EDUCATION
    Region IX, Zamboanga Peninsula
    Division of Zamboanga del Sur
    School/Intrams/District Meet Remarks/Findings:
    District of Lapuyan
    Lapuyan, Zamboanga del Sur
    _____________________________ Ht ._______cm FIT
    Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg UNFIT
    PRC PR:____________bpm
    LICENSE: PTR NO. RR:____________cpm Date:
    Unit/Division Meet Remarks/Findings:

    _____________________________ Ht ._______cm FIT


    Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg UNFIT
    PRC PR:____________bpm
    LICENSE: PTR NO. RR:____________cpm Date:
    Regional Meet Remarks/Findings:

    _____________________________ Ht ._______cm FIT


    Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg UNFIT
    PRC PR:____________bpm
    LICENSE: PTR NO. RR:____________cpm Date:
    Palarong Pambansa Remarks/Findings:

    _____________________________ Ht ._______cm FIT


    Physician/Medical Officer Wt:_______kg
    (signature over printed name) BP.____________mmHg UNFIT
    PRC PR:____________bpm
    LICENSE: PTR NO. RR:____________cpm Date:

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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