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Medical For Coaches, Asst Coaches, Chaperones - v2023

This document is a medical certificate for coaches, assistant coaches, and chaperones in the Republic of the Philippines, specifically for participants in school sports events up to Palarong Pambansa. It includes sections for physical examination results, remarks, and findings, along with the physician's signature and relevant details. The certificate confirms whether the individual is physically fit or unfit to participate in the specified events.

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FRANKLIN BERNALES
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5 views1 page

Medical For Coaches, Asst Coaches, Chaperones - v2023

This document is a medical certificate for coaches, assistant coaches, and chaperones in the Republic of the Philippines, specifically for participants in school sports events up to Palarong Pambansa. It includes sections for physical examination results, remarks, and findings, along with the physician's signature and relevant details. The certificate confirms whether the individual is physically fit or unfit to participate in the specified events.

Uploaded by

FRANKLIN BERNALES
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Revised as of April 2023

Republic of the Philippines MCForm - 3


DEPARTMENT OF EDUCATION
Region VIII
(Region)
Samar Division
(Division)
Gandara Il Central Elementary School
(School)
Dumaloong, Gandara Samar
(School Address)

MEDICAL CERTIFICATE
(COACHES, ASSISTANT COACHES, CHAPERONE)

__________________
(Date)
To Whom It May Concern:

This is to certify that I have personally examined ____________________________


Name
age ______ sex _____ and have 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: ___________________________

Physical Examination

School/Intrams/District Meet Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg FIT


Physician/Medical Officer
BP.____________mmHg
(signature over printed name) UNFIT
PRC PR:____________bpm
LICENSE: PTR NO. Date:
RR:____________cpm

Unit/Division Meet Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg FIT


Physician/Medical Officer
BP.____________mmHg
(signature over printed name) UNFIT
PRC PR:____________bpm
LICENSE: PTR NO. Date:
RR:____________cpm
Regional Meet Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg FIT


Physician/Medical Officer
BP.____________mmHg
(signature over printed name) UNFIT
PRC PR:____________bpm
LICENSE: PTR NO. Date:
RR:____________cpm
Palarong Pambansa Remarks/Findings:

________________________________________ Ht ._______cm Wt:_______kg FIT


Physician/Medical Officer
BP.____________mmHg
(signature over printed name) UNFIT
PRC PR:____________bpm
LICENSE: PTR NO. Date:
RR:____________cpm

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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