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    Medical For Athletes 1

    Uploaded by

    Daianne Gloria
    This document is a medical certificate for participation in school sports competitions up to the Palarong Pambansa level. It contains sections for a physician to examine a student and indicate whether various body parts are normal or abnormal at different competition levels. The physician must then declare whether the student is physically fit or unfit to participate based on the examination results and measurements including height, weight, blood pressure, pulse rate, and respiratory rate.

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

    Medical For Athletes 1

    Uploaded by

    Daianne Gloria
    10 views2 pages
    This document is a medical certificate for participation in school sports competitions up to the Palarong Pambansa level. It contains sections for a physician to examine a student and indicate whether various body parts are normal or abnormal at different competition levels. The physician must then declare whether the student is physically fit or unfit to participate based on the examination results and measurements including height, weight, blood pressure, pulse rate, and respiratory rate.

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    11. Medical for Athletes 1

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    © © All Rights Reserved

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    This document is a medical certificate for participation in school sports competitions up to the Palarong Pambansa level. It contains sections for a physician to examine a student and indicate whether various body parts are normal or abnormal at different competition levels. The physician must then declare whether the student is physically fit or unfit to participate based on the examination results and measurements including height, weight, blood pressure, pulse rate, and respiratory rate.

    Copyright:

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

    Medical For Athletes 1

    Uploaded by

    Daianne Gloria
    This document is a medical certificate for participation in school sports competitions up to the Palarong Pambansa level. It contains sections for a physician to examine a student and indicate whether various body parts are normal or abnormal at different competition levels. The physician must then declare whether the student is physically fit or unfit to participate based on the examination results and measurements including height, weight, blood pressure, pulse rate, and respiratory rate.

    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 April 3 ,2023


    DEPARTMENT OF EDUCATION

    ___III – CENTRAL LUZON__


    (REGION)
    ___CITY OF MALOLOS___
    (DIVISION)
    BULACAN STATE UNIVERSITY
    (SCHOOL)
    BRGY. GUINHAWA, CITY OF MALOLOS, BULACAN
    (School Address)

    MEDICAL CERTIFICATE
    e. hips YES | NO YES | NO YES | NO YES | NO
    To Whom It May Concern: f. thighs YES | NO YES | NO YES | NO YES | NO
    g. knees YES | NO YES | NO YES | NO YES | NO
    This is to certify that I have personally examined ___________________ age h. ankles YES | NO YES | NO YES | NO YES | NO
    Name
    i. feet YES | NO YES | NO YES | NO YES | NO
    ____ sex _____ and have found that he/she is physically fit unfit, during 11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
    (reflexes)
    the time of examination, to join and participate in the lower meets up to Palarong

    School/Intrams/District Meet Remarks/Findings:


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

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)


    Republic of the Philippines MCForm - 1

    DEPARTMENT OF EDUCATION

    ___III – CENTRAL LUZON__


    (REGION)
    ___CITY OF MALOLOS___
    (DIVISION)
    BULACAN STATE UNIVERSITY
    (SCHOOL)
    LICENSE: PTR NO.
    BRGY. GUINHAWA, CITY OF MALOLOS, BULACAN
    Date: (School Address)

    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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