Medical-Form.docx
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This document is a medical certificate from a physician in the Philippines certifying that a student is physically fit or unfit to participate in various athletic competitions based on a physical examination. The examination includes checking eyes, ears, nose, throat, mouth, teeth, neck, heart, lungs, abdomen, skin, genitals, range of motion of joints, and vital signs. The physician indicates whether the student is cleared to participate in intra-school, district, regional, and national athletic meets based on the results of the examination.
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This medical certificate certifies that a student was found physically fit to participate in sepak takraw competitions from the school level up to the national Palarong Pambansa games. The certificate documents the results of the student's physical examination across multiple body systems and finds them normal and fit at each competition level. The physician's signature and license information is required on the certificate for each examination level to verify the student's fitness to participate.
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Here are the matches for the "What Should I Do?" worksheet:
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3) I have a stomachache. f) You shouldn‟t eat anything spicy.
4) I have a backache. k) You shouldn‟t lift heavy things.
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- 1. Republic of the Philippines Department of Education Region I PANGASINAN SCHOOLS DIVISION OFFICE ll Sison MEDICAL CERTIFICATE To whom it may concern; This is to certify that I personally examined _________________________ Event:_____________ Physical Examination f. thighs YES I NO YES I NO YES I NO YES I NO g. knees YES I NO YES I NO YES I NO YES I NO h. ankles YES I NO YES I NO YES I NO YES I NO i. feet YES I NO YES I NO YES I NO YES I NO 11. Neuromuscular YES I NO YES I NO YES I NO YES I NO School/Intrams/ District Meet ________________________ Physician/Medica Officer (Signature Over Printed Name) PRC LICENSE: PTR NO. Remarks/Findings Ht:_____cm Wt:_____kg BP:_______ mm/Hg PR:_______bpm RR: _______cpm FIT UNFIT School/Intrams/ District Meet ________________________ Physician/Medica Officer (Signature Over Printed Name) PRC LICENSE: PTR NO. Remarks/Findings Ht:_____cm Wt:_____kg BP:_______ mm/Hg PR:_______bpm RR: _______cpm FIT UNFIT School/Intrams/ District Meet ________________________ Physician/Medica Officer (Signature Over Printed Name) PRC LICENSE: PTR NO. Remarks/Findings Ht:_____cm Wt:_____kg BP:_______ mm/Hg PR:_______bpm RR: _______cpm FIT UNFIT School/Intrams/ District Meet ________________________ Physician/Medica Officer (Signature Over Printed Name) PRC LICENSE: PTR NO. Remarks/Findings Ht:_____cm Wt:_____kg BP:_______ mm/Hg PR:_______bpm RR: _______cpm FIT UNFIT 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.
- 2. School/Intrams/ District Meet Unit/ Division Meet Regional Meet Palarong Pambansa 1. Eyes YES I NO YES I NO YES I NO YES I NO 2. Ears Nose throat YES I NO YES I NO YES I NO YES I NO 3. Mouth and teeth YES I NO YES I NO YES I NO YES I NO 4. Neck YES I NO YES I NO YES I NO YES I NO 5. Cardiovascular YES I NO YES I NO YES I NO YES I NO 6. Chest and Lungs YES I NO YES I NO YES I NO YES I NO 7. Abdomen YES I NO YES I NO YES I NO YES I NO 8. Skin YES I NO YES I NO YES I NO YES I NO 9. Genetalia-Hernia (Male) YES I NO YES I NO YES I NO YES I NO 10. Muskolosketal: ROM YES I NO YES I NO YES I NO YES I NO a. neck YES I NO YES I NO YES I NO YES I NO b. spine YES I NO YES I NO YES I NO YES I NO c. shoulder YES I NO YES I NO YES I NO YES I NO d. arms/hands YES I NO YES I NO YES I NO YES I NO e. hips YES I NO YES I NO YES I NO YES I NO