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Medical-Certificate DSPC

This document is a medical certificate issued by the Department of Education in the Philippines, certifying the physical fitness of an individual for participation in a specified activity. It includes personal details of the individual, results of a physical examination, and any relevant medical history or findings. The certificate must be signed by a physician or medical officer and includes sections for vaccination status and other health-related inquiries.

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Clint Monsanto
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22 views2 pages

Medical-Certificate DSPC

This document is a medical certificate issued by the Department of Education in the Philippines, certifying the physical fitness of an individual for participation in a specified activity. It includes personal details of the individual, results of a physical examination, and any relevant medical history or findings. The certificate must be signed by a physician or medical officer and includes sections for vaccination status and other health-related inquiries.

Uploaded by

Clint Monsanto
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Education
REGION X – Northern Mindanao
SCHOOLS DIVISION OF MISAMIS ORIENTAL

School: ________________________________________________ School ID: ___________________


School Address: ______________________________________________
Date: ________________________________________________

MEDICAL CERTIFICATE
TO WHOM IT MAY CONCERN:

This is to certify that I have personally


examine
(Name)

, , born on
(Name) (Age) (Sex) (Date of Birth)

and have found that he/she is physically fit/unfit during the time of examination,
to join and attend the on
(Name of Activity)

at .
(Date of Activity) (Place of Activity)

Physical Examination:
Height (m): Weight Blood Type:
(kg):
Blood Pressure: mmHg
Pulse Rate: bpm
Respiratory Rate: cpm
Other Remarks:

Covid-19 Vaccine: Complete Incomplete Primary dose Booster dose:

Other Findings Ye No if Yes, please


s specify
Asthma ☐ ☐
Allergy ☐ ☐
Undergone Operation ☐ ☐
Kidney Infection ☐ ☐
Heart Ailment ☐ ☐
Other ☐ ☐

Physician/ Medical Officer


(Signature Over Printed Name)
License No.
PTR:
Date:

Interviewed & assessed by:

________________________
Republic of the Philippines
Department of Education
REGION X – Northern Mindanao
SCHOOLS DIVISION OF MISAMIS ORIENTAL

________________________

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