CSC FORM 211 MEDICAL CERTIFICATE For Employment

PHILIPPINE CIVIL SERVICE

1. Thi me!i"#l "erti$i"#te ho%l! &e #""ompli he! &y # 'o(ernin' phy i"i#n. 2. Att#"he! thi "erti$i"#te to ori'in#l #ppointment #n! rein t#tement . FOR THE PROPOSED APPOINTEE NAME ) L# t* Fir t* Mi!!le or i$ m#rrie! +om#n* m#i!en N#me, ADDRESS0 A-E0 SE10 CIVIL STAT2S0 PROPOSED POSITION A-ENC./ADDRESS

Pre3employment Me!i"#l3Phy i"#l Te t0 1. 2. 6. 7. 8. 4loo! Te t )C4C, 5 4loo! Type 2rin#ly i Che t 13R#y Dr%' te t Ne%ro3P y"hi#tri" E9#min#tion )$or Perm#nent only,

NOTE: ALL RESULTS OF EXAMINATION MUST BE ATTATCHED TO THIS FORM. FOR THE PHYSICIAN I hereby certify that I have personally examined to the above named Individual and found her/him to be physically and medically fit/unfit for employment PRINTED NAME/SI-NAT2RE OF PH.SICIAN
CERTIFICATE N2M4ER

DOC2MENTAR. STAMP OTHER INFORMATION A4O2T THE PROPOSED APPOINTEE0

Ma. Rizalina Abubo-Mi an!a" M.D.

OFFICIAL DESI-NATION

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4LOOD T.PE0

Me!i"#l O$$i"er I
A-ENC.0 Dep#rtment o$ E!%"#tion Re'ion III Di(i ion o$ City o$ S#n Fern#n!o Sin!#l#n City o$ S#n Fern#n!o )P, DATE E1AMINED0