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    Initial Medical Eval Form

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    ptsievccd
    The document is an initial medical evaluation form for a job applicant to the Bureau of Jail Management and Penology. It collects personal information and conducts an initial physical exam checking for visual, hearing, skeletal, dermatological and communicable disease issues. It also screens for hepatitis B and certifies if the applicant passed or failed the evaluation.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Initial Medical Eval Form

    Uploaded by

    ptsievccd
    147 views1 page
    The document is an initial medical evaluation form for a job applicant to the Bureau of Jail Management and Penology. It collects personal information and conducts an initial physical exam checking for visual, hearing, skeletal, dermatological and communicable disease issues. It also screens for hepatitis B and certifies if the applicant passed or failed the evaluation.

    Original Description:

    Medicla Form

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    The document is an initial medical evaluation form for a job applicant to the Bureau of Jail Management and Penology. It collects personal information and conducts an initial physical exam checking for visual, hearing, skeletal, dermatological and communicable disease issues. It also screens for hepatitis B and certifies if the applicant passed or failed the evaluation.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    147 views1 page

    Initial Medical Eval Form

    Uploaded by

    ptsievccd
    The document is an initial medical evaluation form for a job applicant to the Bureau of Jail Management and Penology. It collects personal information and conducts an initial physical exam checking for visual, hearing, skeletal, dermatological and communicable disease issues. It also screens for hepatitis B and certifies if the applicant passed or failed the evaluation.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines

    Department of the Interior and Local Government


    BUREAU OF JAIL MANAGEMENT AND PENOLOGY
    REGIONAL HEADQUARTERS VIII
    Brgy. Guindapunan Palo, Leyte

    INITIAL MEDICAL EVALUATION FORM for JO1 Attach


    Applicants Passport Size
    Picture
    NAME: (LN,FN,MN)
    HOME ADDRESS:
    CONTACT #: DATE OF BIRTH: (MM/DD/YYYY)

    PLACE OF BIRTH: AGE:


    CIVIL STATUS: GENDER:
    EDUCATION: ELIGIBILITY:

    Requested by:
    Applicant’s Signature C, PRM

    To be filled-up by Health Service Unit

    REMARKS
    HEIGHT in meters
    WEIGHT in kilograms
    Name and Signature of
    Body Mass Index (BMI) Health Personnel

    INITIAL PHYSICAL EXAMINATIONS:

    YES NO REMARKS
    1. No gross/major visual defect
    2. No hearing loss or impairment
    3. No gross deformities of nasal and oropharyngeal
    cavities
    4. No gross deformities that may affect speech,
    mastication and deglution
    5. No gross skeletal deformity that will limit joint
    movement
    6. No dermatologic disease that are communicable
    7. No skin tattoo/s and soft tissue and glandular
    masses
    8. No unusual body piercing/s

    HEPATITIS B SCREENING: __________________________________

    The undersigned hereby certifies that Mr/Ms __________________________, have


    PASSED / FAILED the initial medical evaluation and is RECOMMENDED / NOT
    RECOMMENDED to proceed to the next phase of the recruitment process.

    J/SINSP TADEO P SAN GABRIEL, MD


    Name and Signature of Health Officer

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