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    Medical Certificate - 2023 - Page 1 All Athletes

    Uploaded by

    Audrie Faye Tabaque
    This medical certificate is for a 10-year-old female student to participate in lower meets up to the Palarong Pambansa competition. It documents a physical examination finding her physically fit in 11 areas including eyes, ears, cardiovascular system, lungs, and musculoskeletal system. The examination was conducted for participation at the school/intramural, unit/division, regional, and Palarong Pambansa levels and found her fit for participation at each level based on measurements of height, weight, and vital signs within normal ranges.

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    Medical Certificate - 2023 - Page 1 All Athletes

    Uploaded by

    Audrie Faye Tabaque
    158 views2 pages
    This medical certificate is for a 10-year-old female student to participate in lower meets up to the Palarong Pambansa competition. It documents a physical examination finding her physically fit in 11 areas including eyes, ears, cardiovascular system, lungs, and musculoskeletal system. The examination was conducted for participation at the school/intramural, unit/division, regional, and Palarong Pambansa levels and found her fit for participation at each level based on measurements of height, weight, and vital signs within normal ranges.

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    Medical-Certificate_2023_page-1-all-athletes

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    This medical certificate is for a 10-year-old female student to participate in lower meets up to the Palarong Pambansa competition. It documents a physical examination finding her physically fit in 11 areas including eyes, ears, cardiovascular system, lungs, and musculoskeletal system. The examination was conducted for participation at the school/intramural, unit/division, regional, and Palarong Pambansa levels and found her fit for participation at each level based on measurements of height, weight, and vital signs within normal ranges.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    158 views2 pages

    Medical Certificate - 2023 - Page 1 All Athletes

    Uploaded by

    Audrie Faye Tabaque
    This medical certificate is for a 10-year-old female student to participate in lower meets up to the Palarong Pambansa competition. It documents a physical examination finding her physically fit in 11 areas including eyes, ears, cardiovascular system, lungs, and musculoskeletal system. The examination was conducted for participation at the school/intramural, unit/division, regional, and Palarong Pambansa levels and found her fit for participation at each level based on measurements of height, weight, and vital signs within normal ranges.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Republic of the Philippines MCForm - 1

    Revised as of September 26, 2019 DEPARTMENT OF EDUCATION


    REGION VI – WESTERN VISAYAS
    (REGION)
    SCHOOLS DIVISION OF ANTIQUE
    (DIVISION)
    ANTIQUE NATIONAL SCHOOL
    (SCHOOL)
    San Jose, Antique
    (School Address)

    MEDICAL CERTIFICATE

    To Whom It May Concern:

    This is to certify that I have personally examined


    Name
    age 10 sex F 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:

    Physical Examination
    School/Intrams/ Unit/Division Regional Palarong
    District Meet Meet Meet Pambansa
    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
    i. feet YES | NO YES | NO YES | NO YES | NO
    11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
    (reflexes)

    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:

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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