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2024 - Medical For Athletes 1

This document is a medical certificate for a student examining their physical fitness to participate in school sports competitions at different levels, from intramurals up to the national Palarong Pambansa games. It includes a physical examination checklist assessing various body parts and systems, and certification from a physician that the student is fit or unfit, with their findings, to participate in each level of competition based on the examination.

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FEY CARL DELOS SANTOS
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© © All Rights Reserved
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575 views1 page

2024 - Medical For Athletes 1

This document is a medical certificate for a student examining their physical fitness to participate in school sports competitions at different levels, from intramurals up to the national Palarong Pambansa games. It includes a physical examination checklist assessing various body parts and systems, and certification from a physician that the student is fit or unfit, with their findings, to participate in each level of competition based on the examination.

Uploaded by

FEY CARL DELOS SANTOS
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
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Republic of the Philippines MCForm - 1

Revised as of September 26, DEPARTMENT OF EDUCATION


IV-A CALABARZON
________________________
(REGION)
SANTA ROSA CITY
______________________________
(DIVISION)
SANTA ROSA ELEMENTARY SCHOOL CENTRAL I
______________________________
(SCHOOL)
RIZAL BLVD. BRGY. MALUSAK, CITY OF SANTA ROSA, LAGUNA
______________________________
(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
11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
age ____ sex _____ and have found that he/she is physically fit unfit,
(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


Physician/Medical Officer Wt:_______kg
Event: _______________________________ (signature over printed name) BP.____________mmHg UNFIT
PRC PR:____________bpm
Physical Examination LICENSE: PTR NO. RR:____________cpm Date:
Unit/Division Meet Remarks/Findings:
School/Intrams/ Unit/Division Regional Palarong
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
PRC PR:____________bpm
2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO 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
Physician/Medical Officer Wt:_______kg
6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO (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
LICENSE: PTR NO. RR:____________cpm Date:
d. arms/hands YES | NO YES | NO YES | NO YES | NO
e. hips YES | NO YES | NO YES | NO YES | NO

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

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