Scribd
Upload
23 views1 page

Medical For Athletes 1

This document is a medical certificate for a student to participate in school sports competitions up to the national Palarong Pambansa games. It contains the student's name, age, sex, and physical examination results for eyes, ears, mouth, cardiovascular system, lungs and more. The physician examines the student and determines if they are physically fit or unfit to participate in competitions at different levels - school, district, regional, and national. For each level of competition, the physician signs and dates the certificate with their findings and determination of fitness.

Uploaded by

marlou john lacdao
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
23 views1 page

Medical For Athletes 1

This document is a medical certificate for a student to participate in school sports competitions up to the national Palarong Pambansa games. It contains the student's name, age, sex, and physical examination results for eyes, ears, mouth, cardiovascular system, lungs and more. The physician examines the student and determines if they are physically fit or unfit to participate in competitions at different levels - school, district, regional, and national. For each level of competition, the physician signs and dates the certificate with their findings and determination of fitness.

Uploaded by

marlou john lacdao
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Republic of the Philippines MCForm - 1

Revised as of September 26, 2019 DEPARTMENT OF EDUCATION


________________________
(REGION)
______________________________
(DIVISION)
______________________________
(SCHOOL)
______________________________
(School Address)

MEDICAL CERTIFICATE
f. thighs YES | NO YES | NO YES | NO YES | NO
To Whom It May Concern: g. knees YES | NO YES | NO YES | NO YES | NO
h. ankles YES | NO YES | NO YES | NO YES | NO
This is to certify that I have personally examined ___________________ i. feet YES | NO YES | NO YES | NO YES | NO
Name
age ____ sex _____ and have found that he/she is physically fit unfit, 11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
(reflexes)
during the time of examination, to join and participate in the lower meets up to
Palarong Pambansa.
School/Intrams/District Meet Remarks/Findings:

_____________________________ Ht ._______cm FIT


Event: ___________________________ Physician/Medical Officer Wt:_______kg
(signature over printed name) BP.____________mmHg UNFIT
PRC PR:____________bpm
Physical Examination LICENSE: PTR NO. RR:____________cpm Date:
School/Intrams/ Unit/Division Regional Palarong Unit/Division Meet Remarks/Findings:
District Meet Meet Meet Pambansa
_____________________________ Ht ._______cm FIT
Normal Normal Normal Normal Physician/Medical Officer Wt:_______kg
1. Eyes YES | NO YES | NO YES | NO YES | NO (signature over printed name) BP.____________mmHg UNFIT
2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm
LICENSE: PTR NO. RR:____________cpm Date:
3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO
Regional Meet Remarks/Findings:
4. Neck YES | NO YES | NO YES | NO YES | NO
5. Cardiovascular YES | NO YES | NO YES | NO YES | NO _____________________________ Ht ._______cm FIT
6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt:_______kg
(signature over printed name) BP.____________mmHg UNFIT
7. Abdomen YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm
8. Skin YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date:
9. Genitalia-Hernia (male) YES | NO YES | NO YES | NO YES | NO Palarong Pambansa Remarks/Findings:
10. Muskuloskeletal: ROM YES | NO YES | NO YES | NO YES | NO
_____________________________ Ht ._______cm FIT
a. neck YES | NO YES | NO YES | NO YES | NO
Physician/Medical Officer Wt:_______kg
b. spine YES | NO YES | NO YES | NO YES | NO (signature over printed name) BP.____________mmHg UNFIT
c. shoulder YES | NO YES | NO YES | NO YES | NO PRC PR:____________bpm
d. arms/hands YES | NO YES | NO YES | NO YES | NO LICENSE: PTR NO. RR:____________cpm Date:

e. hips YES | NO YES | NO YES | NO YES | NO

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

You might also like