PGH Form No.
Q-550099        PHILIPPINE GENERAL HOSPITAL
                                The National University Hospital
                               University of the Philippines Manila
                                     Taft Avenue, Manila
                               PHIC-Accredited Health Care Provider
                                    ISO 9001:2008 Certified
                             Section of Infectious Disease
                              MEDICAL CERTIFICATE
Date:
TO WHOM IT MAY CONCERN:
This is to certify that I have seen and examined
Residing at                                                           .
She/He was diagnosed to
And the following are the recommendations:
BY:
License No.