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Health Certificate: Republic of The Philippines City Health Office Tacloban City

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(Front) (Back)

Republic of the Philippines


CITY HEALTH OFFICE IMPORTANT
Doc. Stamp
Tacloban City This health certificate is non-transferable.
Paid
OR. No. Always wear your certificate in the upper
HEALTH CERTIFICATE left front portion of your garment while
Reg.No. 2022 - 26732 8204346 working.
Valid only until the next date of
examination, as indicated below.

Pursuant to the provision of


PD 522 & PD 856, this LABORATORY EXAMINATION
certificate issued to
LAB EXAM DATE RESULT VERIFIED BY
SPUTUM

Name CARLITO - TONGOL STOOL Mar-10-22 DEWORMED

Age 30 Sex MALE Nationality FILIPINO C-XRAY Mar-25-22 NORMAL


Occupation COLLECTOR HBSAg
Place of Work GOODMOOD MERCHANDISE
HBSAb

SEMINAR/TRAINING ATTENDED
Attach your
(1X1) Signature FHS/ HACCP/ WRSOS Date
Picture ID
here Mar-28-22 Dec-31-22
GLORIA ENRIQUEZ FABRIGAS, MD, MPH, MHA
OIC City Health Office Date of Issue Date of Expiration

Reminders:

Reminders:

1. Falsification of documents is punishable by law.


2. This document has encryted QR Code for security reasons to prevent from data tampering.
3.When printing please use white paper/sheet/card only and a colored printer.
4. Before laminating, please print and cut according to the size and color of the template and attach (1x1) picture ID.
5. This health certificate is non-transferable. Always wear your certificate in the upper left front portion of your garment
while working.

From Tacloban City Health Office

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