Republic of the Philippines
Revised as of February 2024
MCForm - 3
DEPARTMENT OF EDUCATION
Caraga Region
(Region)
Bayugan City Division
(Division)
FILI NATIONAL HIGH SCHOOL
(School)
Purok-2 Fili, Bayugan City, Agusan del Sur
(School Address)
MEDICAL CERTIFICATE
(COACHES, ASSISTANT COACHES, CHAPERONE)
November 5, 2024
__________________
(Date)
To Whom It May Concern:
MYRA G. GALOS
This is to certify that I have personally examined ____________________________
Name
36 sex _____
F
age ______
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.
BADMINTON
Event: ___________________________
Physical Examination
School/Intrams/District Meet
Remarks/Findings:
________________________________________
Physician/Medical Officer
(signature over printed name)
PRC
LICENSE:
PTR NO.
Ht ._______cm
Unit/Division Meet
Remarks/Findings:
________________________________________
Physician/Medical Officer
(signature over printed name)
PRC
LICENSE:
PTR NO.
Ht ._______cm
Regional Meet
________________________________________
Physician/Medical Officer
(signature over printed name)
PRC
LICENSE:
PTR NO.
Palarong Pambansa
________________________________________
Physician/Medical Officer
(signature over printed name)
PRC
LICENSE:
PTR NO.
Wt:_______kg
FIT
BP.____________mmHg
UNFIT
PR:____________bpm
Date:
RR:____________cpm
Wt:_______kg
FIT
BP.____________mmHg
UNFIT
PR:____________bpm
Date:
RR:____________cpm
Remarks/Findings:
Ht ._______cm
Wt:_______kg
FIT
BP.____________mmHg
UNFIT
PR:____________bpm
Date:
RR:____________cpm
Remarks/Findings:
Ht ._______cm
Wt:_______kg
FIT
BP.____________mmHg
UNFIT
PR:____________bpm
RR:____________cpm
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Date:
Republic of the Philippines
DEPARTMENT OF EDUCATION
Caraga Region
(Region)
Bayugan City Division
(Division)
FILI NATIONAL HIGH SCHOOL
(School)
Purok-2 Fili, Bayugan City, Agusan del Sur
(School Address)
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
MCForm - 3