Republic of the Philippines

Department of Education
Region VII, Central Visayas
Division of Carcar City

MEDICAL CERTIFICATE

____________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined ___________________________

age ________ sex _______ born on _______________ and have found that he/she is

physically fit, during the time of examination, to join and compete in the Regional Schools

Press Conference 2024 at Talisay City Division , Talisay City on April 9-12, 2024.

Event : ____________________________

Physical Examination

Date examined: ________________________

Height: _____________ Weight : _____________ Blood Pressure:

______________

Pulse, Resting: ______________________ Respiratory Rate: _______________

Other Remarks:______________________________________________________________

_______________________________________________________________

_______________________________
Physician/Medical Officer
(Signature over Printed Name)
License No. _____________________
PTR : __________________________
Date : __________________________