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CSC Form No. 211 Medical Certificate

This medical certificate form is used by the Philippine Civil Service to document the results of pre-employment medical exams. It requires a government physician to examine the applicant and certify their fitness for the proposed position based on tests of blood, urine, chest x-ray, drugs, and neuropsychiatric evaluation if needed. The form collects identifying information about the applicant such as name, address, age, sex, civil status, and proposed position. It also records their height, weight, and the date of the medical exam.

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Nora L. Bucu
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129 views2 pages

CSC Form No. 211 Medical Certificate

This medical certificate form is used by the Philippine Civil Service to document the results of pre-employment medical exams. It requires a government physician to examine the applicant and certify their fitness for the proposed position based on tests of blood, urine, chest x-ray, drugs, and neuropsychiatric evaluation if needed. The form collects identifying information about the applicant such as name, address, age, sex, civil status, and proposed position. It also records their height, weight, and the date of the medical exam.

Uploaded by

Nora L. Bucu
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

CSC FORM NO.

211(1997)
MEDICAL CERTIFICATE For Employment

PHILIPPINE CIVIL SERVICE INSTRUCTIONS

1. This medical certificate should be accomplished by a government physician. 2. Attached this certificate to original appointment and reinstatement. ______________________________________________________________________________ NAME (Last, First, Middle or if married woman, AGENCY Maiden Name) 1 ______________________________________________________ ADDRESS ______________________________________________________ AGE SEX _____________________ PROPOSED POSITION
______________________

CIVIL STATUS

_______________________ _____________________________ _____________________ Pre-Employment Medical - Physical Tests 1. Blood test 2. Urinalysis 3. Chest X-ray 4. Drug test 5. Neuro Psychiatric Examination (if necessary) NOTE: ALL RESULTS OF EXAMINATIONS MUST BE ATTACHED TO THIS FORM FOR THE PHYSICIAN I HEREBY CERTIFY that I personally examined the above-mentioned individual and found him/her to be physically and normally fit/unfit for employment. SIGNATURE OF PHYSICIAN CERTIFICATE NUMBER Affix Documentary stamp

Other information about the appointee:

OFFICIAL DESIGNATION

HEIGHT (Bare feet)

WEIGHT (Stripped)

AGENCY

DATE EXAMINED

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