Revised as of September 26, 2019 Republic of the Philippines

DEPARTMENT OF EDUCATION
VI-WESTERN VISAYAS
(Region)
AKLAN
(Division)
MALOCO NATIONAL HIGH SCHOOL
(School)
MALOCO, IBAJAY, AKLAN
(School Address)

MEDICAL CERTIFICATE

To Whom It May Concern: h. ankles YES | NO YES | NO YES | NO YES | NO

This is to certify that I have personally examined ICEE JOY D. GUSI i. feet YES | NO YES | NO YES | NO YES | NO
11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
age 16 sex FEMALE and have found that he/she is physically fit unfit,
(reflexes)
during the time of examination, to join and participate in the lower meets up to Palarong
Pambansa.
Event: BADMINTON GIRLS - SECONDARY

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
School/Intrams/District Meet Remarks/Findings:

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Revised as of September 26, 2019 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI-WESTERN VISAYAS
(Region)
AKLAN
(Division)
MALOCO NATIONAL HIGH SCHOOL
(School)
MALOCO, IBAJAY, AKLAN
(School Address)

_____________________________ 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)

Revised as of September 26, 2019 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI-WESTERN VISAYAS
(Region)
AKLAN
(Division)
MALOCO NATIONAL HIGH SCHOOL
(School)
MALOCO, IBAJAY, AKLAN
(School Address)

MEDICAL CERTIFICATE

To Whom It May Concern: h. ankles YES | NO YES | NO YES | NO YES | NO

This is to certify that I have personally examined IRINE MARCHELLE B. VALERIANO i. feet YES | NO YES | NO YES | NO YES | NO
11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
age 15 sex FEMALE and have found that he/she is physically fit unfit,
(reflexes)
during the time of examination, to join and participate in the lower meets up to Palarong
Pambansa.
Event: BADMINTON GIRLS - SECONDARY

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
School/Intrams/District Meet Remarks/Findings:

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Revised as of September 26, 2019 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI-WESTERN VISAYAS
(Region)
AKLAN
(Division)
MALOCO NATIONAL HIGH SCHOOL
(School)
MALOCO, IBAJAY, AKLAN
(School Address)

_____________________________ 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)

Revised as of September 26, 2019 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI-WESTERN VISAYAS
(Region)
AKLAN
(Division)
MALOCO NATIONAL HIGH SCHOOL
(School)
MALOCO, IBAJAY, AKLAN
(School Address)

MEDICAL CERTIFICATE

To Whom It May Concern: i. feet YES | NO YES | NO YES | NO YES | NO

This is to certify that I have personally examined NERIZA MAE S. SOLIDUM 11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
(reflexes)
age 17 sex FEMALE and 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: BADMINTON GIRLS - SECONDARY

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

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Revised as of September 26, 2019 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI-WESTERN VISAYAS
(Region)
AKLAN
(Division)
MALOCO NATIONAL HIGH SCHOOL
(School)
MALOCO, IBAJAY, AKLAN
(School Address)

School/Intrams/District 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:
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:
MEDICAL CERTIFICATE

To Whom It May Concern: age 17 sex FEMALE and have found that he/she is physically fit unfit,
This is to certify that I have personally examined ELLYZA REIGNE L.
during the time of examination, to join and participate in the lower meets up to Palarong
GARCIA
Pambansa.

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Revised as of September 26, 2019 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI-WESTERN VISAYAS
(Region)
AKLAN
(Division)
MALOCO NATIONAL HIGH SCHOOL
(School)
MALOCO, IBAJAY, AKLAN
(School Address)

School/Intrams/District Meet Remarks/Findings:

Event: BADMINTON GIRLS - SECONDARY
_____________________________ Ht ._______cm FIT
Physician/Medical Officer Wt:_______kg
Physical Examination
(signature over printed name) BP.____________mmHg UNFIT
School/ Unit/Division Regional Palarong PRC PR:____________bpm
Intrams/District Meet Meet Pambansa LICENSE: PTR NO. RR:____________cpm Date:
Meet Unit/Division Meet Remarks/Findings:
Normal Normal Normal Normal
1. Eyes YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT
2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg
(signature over printed name) BP.____________mmHg UNFIT
3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO
PRC PR:____________bpm
4. Neck YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date:
5. Cardiovascular YES | NO YES | NO YES | NO YES | NO
Regional Meet Remarks/Findings:
6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO
7. Abdomen YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT
8. Skin YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg
9. Genitalia-Hernia (male) YES | NO YES | NO YES | NO YES | NO (signature over printed name) BP.____________mmHg UNFIT
10. Muskuloskeletal: ROM YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm
a. neck YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date:
b. spine YES | NO YES | NO YES | NO YES | NO Palarong Pambansa Remarks/Findings:
c. shoulder YES | NO YES | NO YES | NO YES | NO
_____________________________ Ht ._______cm FIT
d. arms/hands YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg
e. hips YES | NO YES | NO YES | NO YES | NO (signature over printed name) BP.____________mmHg UNFIT
f. thighs YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm
g. knees YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date:
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)