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Med Cert Sample

This document is a medical certificate certifying the health status of an individual following a medical examination. It includes personal details, examination results, and physician information. The certificate is valid for a specified number of months from the examination date.

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iaestanislao2366qc
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68 views1 page

Med Cert Sample

This document is a medical certificate certifying the health status of an individual following a medical examination. It includes personal details, examination results, and physician information. The certificate is valid for a specified number of months from the examination date.

Uploaded by

iaestanislao2366qc
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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MEDICAL CERTIFICATE

DATE: ______________

TO WHOM IT MAY CONCERN,

This is to certify that ___________________________, _____ years of age and a


resident of ________________________________________ came in for a medical
examination on ______________________________ and the result revealed that
he/she is ________________________________.

This certification is issued upon the request of the interested party for
whatever purposes it may serve.

Physical Examination:

Height _____Weight ______Blood Pressure _________ PR ______RR ______

Other Remarks ___________________________________________

Physician’s signature ______________________


Physician's Name _________________________
Physician's License Number ________________

Note: This certificate is valid for ________________ months from the date of examination.

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