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    Med Cert Template

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    Christian Roque
    A medical certificate from the ABC Mental Hospital in Manila certifies that a patient named [NAME] who is [AGE] years old was examined/treated/confined on [DATE] for a diagnosis of [DIAGNOSIS]. No operation was performed. The certificate was issued at the request of [REQUESTOR] for [REASON] with case number [CASE NUMBER] and signed by the attending physician with license number [LICENSE NUMBER].

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    Med Cert Template

    Uploaded by

    Christian Roque
    11K views1 page
    A medical certificate from the ABC Mental Hospital in Manila certifies that a patient named [NAME] who is [AGE] years old was examined/treated/confined on [DATE] for a diagnosis of [DIAGNOSIS]. No operation was performed. The certificate was issued at the request of [REQUESTOR] for [REASON] with case number [CASE NUMBER] and signed by the attending physician with license number [LICENSE NUMBER].

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    Med Cert Template

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    A medical certificate from the ABC Mental Hospital in Manila certifies that a patient named [NAME] who is [AGE] years old was examined/treated/confined on [DATE] for a diagnosis of [DIAGNOSIS]. No operation was performed. The certificate was issued at the request of [REQUESTOR] for [REASON] with case number [CASE NUMBER] and signed by the attending physician with license number [LICENSE NUMBER].

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    11K views1 page

    Med Cert Template

    Uploaded by

    Christian Roque
    A medical certificate from the ABC Mental Hospital in Manila certifies that a patient named [NAME] who is [AGE] years old was examined/treated/confined on [DATE] for a diagnosis of [DIAGNOSIS]. No operation was performed. The certificate was issued at the request of [REQUESTOR] for [REASON] with case number [CASE NUMBER] and signed by the attending physician with license number [LICENSE NUMBER].

    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

    CITY OF MANILA
    ABC MENTAL HOSPITAL

    Department of Psychiatry
    Quirino Ave. corner Roxas Blvd., Malate, Manila

    MEDICAL CERTIFICATE

    __________, 20___

    To whom it may concern:

    This is to certify that according to his/her case records on this hospital Mr. _________________________, ___________
    years of age, has been examined/treated/confined on _____________________ with a diagnosis of :

    OPERATION PERFORMED:____________________________________________________________________

    This certification is being issued upon request of ____________________________________ for


    ______________________________
    Case No._______________

    _____________________
    Attending Physician
    License No. ________________

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