HI - PRECISION DIAGNOSTICS PLUS

1852 Taft Avenue, Malate Manila Tel. No. 405- 0039 / 405-
0135
MEDICAL REPORT

COMPANY NAME DATE OF EXAMINATION

JVA Builders 7/03/2024 8:35:50AM
PATIENT NAME BIRTHDATE
CALIPES, JOMAR MENDEZ 11/13/1996

I hereby certify that all the information I have disclosed, as reflected in this report, are true to the best of my
knowledge and belief, and that any misrepresentation or concealment on my part may lead to consequences, which
may or may not include termination, legal prosecution, expulsion, disqualification, etc.

I hereby authorize Hi-Precision Diagnostics and its officially designated examining physicians and staff to conduct
the examinations necessary to assess my fitness to work.

I give my consent to this clinic and its officially designated examining physicians and staff to furnish the results of this
examination to my potential employers or their authorized representatives

By signing this, I hold Hi-Precision Diagnostics and it’s authorized physicians and staff free from any criminal, civil,
administrative, ethical, and moral liability, that may arise from the above.

CALIPES, JOMAR MENDEZ

Printed name and Signature of
Patient

MEDICAL EXAMINATION RATING SYSTEM

(Occupational Safety and Health Standards)
Department of Labor and Employment

RECOMMENDATION:
 Class A - Physically fit for any
work.
Class B - Physically under-developed or with correctible defects, (error of refraction dental caries,defective hearing,
and other similar defects) but otherwise fit to work.
Class C - Employable but owing to certain impairments or conditions, (heart disease, hypertension, anatomical
defects )
requires special placement or limited duty in a specified or selected assignment requiring follow -up
treatment/periodic evaluation.
Class D - Unfit or unsafe for any type of employment (active PTB, advanced heart disease with threatened failure,
malignant hypertension, and other similar illnesses).

Physician: JOCELYN A. BENJAMIN, MD

License #: 60452
** Report Electronically Signed Out **

CALIPES, JOMAR MENDEZ -

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 HI - PRECISION DIAGNOSTICS PLUS
1852 Taft Avenue, Malate Manila Tel. No. 405- 0039 / 405-
0135
MEDICAL REPORT

Date: 07/03/2024 1:59:03PM

CALIPES, JOMAR MENDEZ -

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 HI - PRECISION DIAGNOSTICS PLUS
1852 Taft Avenue, Malate Manila Tel. No. 405- 0039 / 405-
0135
MEDICAL REPORT

COMPANY NAME DATE OF EXAMINATION

JVA Builders 7/03/2024 8:35:50AM
PATIENT NAME BIRTHDATE
CALIPES, JOMAR MENDEZ 11/13/1996
SEX AGE CIVIL STATUS TEL NO OCCUPATION
M 28 Single 0 N/A
MEDICAL HISTORY (For any Yes answers, please see Remarks)
Yes No Yes No
1. Head or Neck Injury Condition [ ] [ X ] 22. Hepatitis [ ] [ X ]
2. Eye Disease [ ] [ X ] 23.Tuberculosis [ ] [ X ]
3. Ear Disease or Deafness [ ] [ X ] 24.Malaria [ ] [ X ]
4. Nose or Throat Disease [ X ] [ ] 25.Dengue [ ] [ X ]
5. Skin / Scalp / Nail / Hair Condition [ ] [ X ] 26.Typhoid [ ] [ X ]
6. Asthma or Other Lung Disease [ ] [ X ] 27.Other Tropical / Parasitic Diseases [ ] [ X ]
7. Diabetes Mellitus [ ] [ X ] 28.Cancer / Tumor / Blood Dyscrasia [ ] [ X ]
[ ] [ X ] 29.Hospitalization / Operations [ ] [ X ]
8. Thyroid Disease
[ ] [ X ] 30. Smoker - Cigarette [ ] [ X ]
9. Other Endocrine Disease
30 a. sticks/day for years.
10.High Blood Pressure [ ] [ X ]
[ [ X ] 30 b. Quit smoking since
11.Heart Disease ]
12.Digestive System Condition [ ] [ X ] 31.Alcoholic Beverage Drinker [ ] [ X ]
13.Hernia [ ] [ X ] 31 a. ( ) bottle(s) ( ) glasses ( ) shot(s) /
14.Kidney or Bladder Condition [ ] [ X ] session 31 b. ( ) Occasional ( ) Frequent
15.Female Reproductive System Condition [ ] [ X ] 32. Last Menstrual Period: G. 3 P. 3 (3-0-0-3)
16.Male Reproductive System Condition [ ] [ X ] 32 a. ( ) Reg ( ) Irreg ( ) Menopausal ( ) Surg.
17.Sexually Transmitted Disease [ ] [ X ] Menopause 32 b. ( ) Pregnant ( ) Post Partum (
18.Musculoskeletal Condition [ ] [ X ] ) No Menarche
19.Frequent Headaches / Dizziness [ ] [ X ] 33.Present Medications [ ] [ X ]
20.Psychiatric Condition [ ] [ X ] 34.Congenital Disease / Deformity [ ] [ X ]
21.Seizures, Other Neurologic Disorders [ ] [ X ] 35. Allergies [ ] [ X ]
36.Family Medical History [ X ] [ ]
PHYSICAL EXAMINATION
37. HEIGHT 38. WEIGHT 39. BLD. PRESSURE 40. PULSE 41. RESPIRATION 42. BMI
174.0cm 55.0k 120/70 mmHg 89/ 17/ 24.8 kg/m 2 Normal
g min min
43. Visual Acuity Far Vision Near Vision
Uncorrecte OD 20 / 40 OS 20 / 32
d
Corrected ( ) with eyeglasses ( ) with contact lenses
Normal MEDICAL HISTORY AND PHYSICAL EXAM REMARKS
Yes No 4. Allergic rhinitis, triggered by: dust and pollen
44. Skin X
45. Head, Scalp X
46. Eyes X
47. Ears X
48. Nose, Sinuses X
49. Mouth, Throat X
50. Thyroid, Neck X
51. Breast - Axilla X
52. Lungs X
53. Heart X
54. Abdomen X
55. Back X
56. Anus-rectum X
57. G-U System, X
Inguinal

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 HI - PRECISION DIAGNOSTICS PLUS
1852 Taft Avenue, Malate Manila Tel. No. 405- 0039 / 405-
0135
MEDICAL REPORT

58. Extremities X
Examining SHAYNE MARICON C. CAMMA, MD PRC License #: 140255
Physician:

CALIPES, JOMAR MENDEZ -

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 HI - PRECISION DIAGNOSTICS PLUS
1852 Taft Avenue, Malate Manila Tel. No. 405- 0039 / 405-
0135
MEDICAL REPORT

COMPANY NAME DATE OF EXAMINATION

JVA Builders 7/03/2024 8:35:50AM
PATIENT NAME BIRTHDATE
CALIPES, JOMAR MENDEZ 11/13/1996

TEST SUMMARY
Test Findings Recommendations

MEDICAL NORMAL
HISTORY

PE NORMAL

CBC NORMAL

FECALYSIS NORMAL

URINALYSIS NORMAL

X-RAY NORMAL

ECG NORMAL

Evaluation Date Remarks Classification Evaluator

7/03/2024 CLASS A JOCELYN A. BENJAMIN,

1:59PM MD, License No.: 60452

ADDITIONAL EVALUATION REMARKS

CALIPES, JOMAR MENDEZ -

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