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Medical Certificate for Sports Participation

This medical certificate certifies that Jeztan Aldrei B. Osquiza, a 14 year old male student, was found to be physically fit after a physical examination. The examination covered various body systems and ranges of motion for events ranging from intra-school meets up to the Palarong Pambansa national games. The physician determined the student was fit to participate in dance sports based on the results of the examination.

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F. Lagan Sr. Memorial National High School 301694
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18 views1 page

Medical Certificate for Sports Participation

This medical certificate certifies that Jeztan Aldrei B. Osquiza, a 14 year old male student, was found to be physically fit after a physical examination. The examination covered various body systems and ranges of motion for events ranging from intra-school meets up to the Palarong Pambansa national games. The physician determined the student was fit to participate in dance sports based on the results of the examination.

Uploaded by

F. Lagan Sr. Memorial National High School 301694
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Republic of the Philippines MC Form 1

DEPARTMENT OF EDUCATION
MIMAROPA__
(Region)
PALAWAN___
(Division)
F. LAGAN SR. MEMORIAL NATIONAL HIGH SCHOOL__
(School)
CARAMAY, ROXAS, PALAWAN____
(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
This is to certify that I have personally examined JEZTAN ALDREI B. OSQUIZA h. ankles YES | NO YES | NO YES | NO YES | NO
(NAME) i. feet YES | NO YES | NO YES | NO YES | NO
Age 14 sex Male and have found that he/she is physically fit unfit, during the time of 11. Neuromuscular YES | NO YES | NO YES | NO YES | NO
(reflexes)
examination, to join and participate in the lower meets up to Palarong Pambansa.
School/Intrams/District Meet Remarks/Findings:
Event: Dance Sports
Ht . cm FIT
Physical Examination Physician/Medical Officer Wt: kg
(signature over printed name) BP. mmHg UNFIT
School/Intrams/ Unit/Division Regional Palarong PRC PR: bpm
District Meet Meet Meet Pambansa LICENSE: PTR NO. RR: cpm Date:
Normal Normal Normal Normal Unit/Division Meet Remarks/Findings:
1. Eyes YES | NO YES | NO YES | NO YES | NO Ht . cm FIT
2. Ears, Nose, Throat YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt: kg
3. Mouth and Teeth YES | NO YES | NO YES | NO YES | NO (signature over printed name) BP. mmHg UNFIT
4. Neck YES | NO YES | NO YES | NO YES | NO PRC PR: bpm
LICENSE: PTR NO. RR: cpm Date:
5. Cardiovascular YES | NO YES | NO YES | NO YES | NO
Regional Meet Remarks/Findings:
6. Chest and Lungs YES | NO YES | NO YES | NO YES | NO
7. Abdomen YES | NO YES | NO YES | NO YES | NO Ht . cm FIT
8. Skin YES | NO YES | NO YES | NO YES | NO Physician/Medical Officer Wt: kg
(signature over printed name) UNFIT
9. Genitalia-Hernia (male) YES | NO YES | NO YES | NO YES | NO BP. mmHg
PRC PR: bpm
10. Muskuloskeletal: ROM YES | NO YES | NO YES | NO YES | NO Date:
LICENSE: PTR NO. RR: cpm
a. neck YES | NO YES | NO YES | NO YES | NO
Palarong Pambansa Remarks/Findings:
b. spine YES | NO YES | NO YES | NO YES | NO
c. shoulder YES | NO YES | NO YES | NO YES | NO
Physician/Medical Officer
d. arms/hands YES | NO YES | NO YES | NO YES | NO (signature over printed name) Ht . cm FIT
e. hips YES | NO YES | NO YES | NO YES | NO PRC Wt: kg
LICENSE: PTR NO. BP. mmHg UNFIT
PR: bpm
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
RR: cpm Date:

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