Transcription of MEDICAL CERTIFICATE FOR HIKING - Pinoy …
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MEDICAL CERTIFICATE FOR HIKING - Pinoy …
MEDICAL CERTIFICATE FOR HIKING To whom it may concern: This is to cer?fy that the pa?ent has been examined by the undersigned on _____ (MM/DD/YY) Based on the details regarding the climb, the personal informa?on provided by the pa?ent and the physical examina?on, I confirm that the pa?ent is: Fit to par?cipate in the climb Not fit to par?cipate in the climb Recommenda?ons: _____ AQached are the details of the history and physical examina?on. Signature over printed name of physician: _____ License number: _____ PREPARED BY PITO MAGNO, MD AND GIDEON LASCO, MD, MSC. MUST BE FILLED OUT ONLY BY A LICENSED PHYSICIAN. PAGE 1 OF 2 Patient Name:Age/SexAddress:Blood typeContact no.: Climb informationDestination:Days required:OrganizerDifficulty and elevationHISTORY AND PHYSICAL EXAMINATION Signature over printed name of physician: _____ License number: _____ PREPARED BY PITO MAGNO, MD AND GIDEON LASCO, MD, MSC.
MEDICAL CERTIFICATE FOR HIKING To whom it may concern: This is to cer?fy that the pa?ent has been examined by the undersigned on _____ (MM/DD/YY)
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