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    CITY MEET MC 1

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    budbatz0802

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    © All Rights Reserved
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    CITY MEET MC 1

    Uploaded by

    budbatz0802
    1 views2 pages

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    1 views2 pages

    CITY MEET MC 1

    Uploaded by

    budbatz0802

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    01+047Revised as of February 2024 Republic of the Philippines MCForm - 1

    Department of Education
    REGION III
    OLONGAPO CITY
    IANTHE CHRISTIAN ACADEMY, INC
    PACHECO ST. GORDON HEIGHTS, OLONGAPO CITY

    MEDICAL CERTIFICATE

    To Whom It May Concern:


    This is to certify that I have personally examined ALTHEA DOMINIQUE M. PAREDES , age: 9
    and have been 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: School/Intrams/District Meet Remarks/Findings:


    School/Intrams/ Unit/Division Palarong
    Regional Meet
    District Meet Meet Pambansa 0
    Normal Normal Normal Normal Ht ._______cm Wt:_______kg FIT
    Physician/Medical Officer
    1. Eyes YES|NO YES|NO YES|NO YES|NO (signature over printed name) BP.____________mmHg
    2. Ears, Nose, Throat YES|NO YES|NO YES|NO YES|NO PRC PR:____________bpm UNFIT
    3. Mouth and Teeth YES|NO YES|NO YES|NO YES|NO LICENSE: PTR NO. RR:____________cpm Date:
    4. Neck YES|NO YES|NO YES|NO YES|NO Unit/Division Meet Remarks/Findings:
    5. Cardiovascular YES|NO YES|NO YES|NO YES|NO 0
    6. Chest and Lungs YES|NO YES|NO YES|NO YES|NO Physician/Medical Officer Ht ._______cm Wt:_______kg FIT
    7. Abdomen YES|NO YES|NO YES|NO YES|NO (signature over printed name) BP.____________mmHg
    8. Skin YES|NO YES|NO YES|NO YES|NO PRC PR:____________bpm UNFIT
    9. Genitalia-Hernia (male) YES|NO YES|NO YES|NO YES|NO LICENSE: PTR NO. RR:____________cpm Date:
    10. Muskuloskeletal: ROM YES|NO YES|NO YES|NO YES|NO Regional Meet Remarks/Findings:
    a. neck YES|NO YES|NO YES|NO YES|NO 0
    _____________________________
    b. spine YES|NO YES|NO YES|NO YES|NO Physician/Medical Officer Ht ._______cm Wt:_______kg FIT
    c. shoulder YES|NO YES|NO YES|NO YES|NO (signature over printed name) BP.____________mmHg
    d. arms/hands YES|NO YES|NO YES|NO YES|NO PRC PR:____________bpm UNFIT
    e. hips YES|NO YES|NO YES|NO YES|NO LICENSE: PTR NO. RR:____________cpm Date:
    f. thighs YES|NO YES|NO YES|NO YES|NO Palarong Pambansa Remarks/Findings:
    g. knees YES|NO YES|NO YES|NO YES|NO 0
    _____________________________
    h. ankles YES|NO YES|NO YES|NO YES|NO Physician/Medical Officer Ht ._______cm Wt:_______kg FIT
    i. feet YES|NO YES|NO YES|NO YES|NO (signature over printed name) BP.____________mmHg
    11. Neuromuscular (reflexes) YES|NO YES|NO YES|NO YES|NO PRC PR:____________bpm UNFIT
    FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa) LICENSE: PTR NO. RR:____________cpm Date:
    01+047Revised as of February 2024 MCForm - 1

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