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MED-01688 06-2022
Republic of the Philippines
SOCIAL SECURITY SYSTEM
MEDICAL CERTIFICATE
THIS FORM MAY BE REPRODUCED ANO IS NOT FOR SALE. TH1S CAN ALSO BE DOWNLOADED THRU THE SSS WEBSITE AT www.sss.gov.ph
Please read the instructions below before filling out this form . Use black ink only.
PART I • TO BE FILLED OUT BY MEMBER
NAME (LAST NAME) (FIRST NAME) (MIGOU: NA c:) {SuFF,X)

MJtCl\ttl LI b ~ . CAf2JYlfLl) p~(l(,Df-J

PART 11 ·TOBE FILLED OUT BY ATTENDING PHYSICIAN
A. ILLNESS/INJURY DETAILS
DlAG ~SI

PERTINENT PHYSICAL EXAMINATION INDINGS

(fc.lfvt,U,t- &.

el s of operation)

e B. CONFINEMENT DETAILS

D Still confined DATE DlSCHAR_9ED (MM/DulYYYY)

i OC, I l f q)fr.$
C. CERTIFICATION

I certify to the following :

• That I have seen and examined the above-named patient
• That the information in this form are true and correct
• That the illness/injury
□ (For Disability) is permanent in nature. ~J
D (For Sickness) confinement including recuperation period may last-----~----- days.
("l:>. ot daysi

This certificate is issued for whate e it may serve with regards to the SSS medical claim by the patient.

(]'vvJ_p 23 1--J Y_3

DATE ACCOMPLISHEd

NUMBER

{SU8DIV,S10N) (o {}!/II LCODE

l)
INSTRUCTIONS
1. The member's attending physician shall accomplish this form in one (1) copy.
2. Fill•out and check all applicable items.
3. PRC number is not requ ired for physician practicing abroad.
Medical Certificate Page 1 of 1
 srr. <P}IV£'SJfOS<Pl'l'}I£ OP 1£01£0, l:NC.
Gen. Luna St., Iloilo City
Tel. Nos: (033) 337-2741 to 49 Fax: (033) 336-0207
sphiloilo@gmail.com

MEDICAL CERTIFICATE

July 04, 2023

To whom it may concern:

This is to certify that as per hospital records of MR. REY CARMELO PARCON
MACAHILIG, 52 years old, MALE/MARRIED, and a resident of RIZAL ST., BRGY.
PRIMITIVO LEDESMA WARD (POB.), POTOTAN, ILOILO, PHILIPPINES 5008, was
confined in this hospital on June 7, 2023 at 03:27 PM to June 15, 2023 at 02:10 PM for
the following:

FINDINGS/DIAGNOSIS:

SUPERIOR VENA CAVA SYNDROME SECONDARY TO PULMONARY MASS

RULE IN MALIGNANCY
OBSTRUCTIVE PNEUMONIA- HIGH RISK WITH HYPOXIA
DIABETES MELLITUS TYPE 2- NON INSULIN REQUIRING WITHOUT
COMPLICATIONS
HYPERTENSIVE CARDIOVASCULAR DISEASE
INTERNAL JUGULAR VEIN THROMBOSIS

RODROSE GUZMAI:::LEGIO, M.D.

Attending Physician
F-MRD-001 2020
License No: 0077233
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ST. PAUL'S H_OSPITAL o·F ILOILO, INC.

Gen. ~u_n a St. lloilo City, 5000 Philippines
·_ Tel. Nos.- (033) 3372741-49 local 2043- fiax No. (033) 3351177
Email: sphiloilo@gmail.com • www.sphiloilo.com
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Patient Name : _: : MACA·~ILI~, ·_REY CARMELO· PARCON Patient ID : 0240775

Date .of Birth::_ : 07/16/1970 ;:_,·:· ., - Age ·: 52Y _Sex : M - • • R·equest" No. -: 0000812896
Physician ·:: - : TRIVIL~'~ 10:'.R.ODROSE GUZMAN Draw Date & Time .: ·0 6/07 /23 4:55 PM
.Location _ : ER • '. • . Patient Mobile No. :09980145818

--- CHEMISTRY DEPARTMENT

Test - Result Unit _Normal .Range

-Hemo'globih A~C 6.5 % 4.3 - 6.4

Reported Date : 06/07/2023 5:29 PM Reference No.: 20391337203

P.DEMAVIVAS, RMT •
PRC UC. #71400 .
Medical Technologist Pathologist
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~35-1177 .••

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AGE: 52YO DATE: 6/7/2023
ROOM: 8510 TIME: 3:35PM

ill~
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· .Gen. Luna St., Iloilo City

:·_ Tel / Nos; (033) ~37-2741 to 49 Fax: .(033) 335-1177
.,

·_ ECG OFFICIAL R-ES_UL T

•· NAME::)v1ACAH_JUG/ REY CARMELO PARCON AGE: 52YO ROOM 8510

• • ATTENDING PHYSICIAN: DR. TRIVILEGIO SEX: M DATE: 6/7/2023
TAKEN BY: ER TIME 3:35PM

MEAN ELECTRICAL AXIS

p
QRS
ST
T

-90°
-120° -AVF -90°
- II -60° -120° -60°
; - Ill
'' I
I

'' ,,
\ I
-150° -150° ''
+AVR •....
\
\ I
. -30°

'.._
' \

\
\
.
I I
'
,,
I

, .,,
,

+ 180~ - - - - - - - - - - -'.:-~I:-:'_ - - - - - - - - - - oo
.... < ' I'>,..
.,, ,'
V6
I ",
, \
I \

,,' ' .. ·+30°

, \
\ \/5
I

+120° +60°
V1 +90° V4
V2

FRONTAL PLANE HORIZONTAL PLANE

INTERPRETATION
RATE: ATRIAL: VENTICULA.R: RHYTHM:
PR:
- - - - QRS:
- - - - - QT: - - - - AXIS: ·
QT RATIO:
- -
DESCRIPTION:
- - ----- ----

REMARKS:

F-CAR-.003 Page 2 of 2
Revision # - 00