Scribd
Upload
27 views

MEDICAL FORM 2024

Uploaded by

sub69532
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
27 views

MEDICAL FORM 2024

Uploaded by

sub69532
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/ 2

Office for Student Affairs and Services

MEDICAL CERTIFICATE
DATE: ___________________
To whom it may concern:

This is to certify that ____________________________________, _______________ years old


NAME AGE
____________________, a resident of __________________________________________ was
CIVIL STATUS HOME ADDRESS
seen and examined by the undersigned and was found to be physically fit at the time of
examination.

Remarks:
Blood Pressure:
Pulse Rate:
VALID FOR 6 MONTHS FROM THE DATE EXAMINED.
CORALYN V. BAUTISTA, M.D.
School Physician
License No. 75872

Office for Student Affairs and Services


STUDENT’S COPY

MEDICAL CERTIFICATE
DATE: ___________________
To whom it may concern:

This is to certify that ____________________________________, _______________ years old


NAME AGE
____________________, a resident of __________________________________________ was
CIVIL STATUS HOME ADDRESS
seen and examined by the undersigned and was found to be physically fit at the time of
examination.

Remarks:

Blood Pressure:
Pulse Rate:
VALID FOR 6 MONTHS FROM THE DATE EXAMINED.
CORALYN V. BAUTISTA, M.D.
School Physician
License No. 75872
Office for Student Affairs and Services

Student Center Bldg., MinSU Main Campus, Alcate, Victoria, Oriental Mindoro | Mobile: 09278071202
[email protected] | www.minsu.edu.ph

You might also like