CSC FORM 211 (Revised August 1998) PHILIPPINE CIVIL

SERVICE
MEDICAL CERTIFICATE

INSTRUCTIONS
1. This medical certificate should be accomplished by a government physician
2. Attach this certificatre to original appointment and reinstaements

FOR THE PROPOSED APPOINTEE

Name ( Last, First, Middle, or if woman, Maiden Name) Agency/ADDRESS

TEJANO, MYLENE OCHEDA
ADDRESS
P-14, Don Carlos Sur (Pob.), Don Carlos, Bukidnon PROPOSED POSITION
AGE SEX CIVIL
51 years FEMALE STATUS
Married

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 THIS EXAMINATION MUST BE ATTACHED TO THIS FORM FOR THE
PHYSICIAN

I hereby certify that I have personally examindd the aboce mentioned AFFIX
individual and found DOCUMENTARY
Her/him to be physically and mentally fit/unfit for employment STAMP HERE

PRINTED NAME/SIGNATURE OF CERTIFICATION OTHER INFORMATION ANOUT THE

PHYSICIAN NUMBER PROPOSED APPOINTEE

MARVIN ARIES H. CABIGAS, MD

OFFICIAL DESIGNATION HEIGHT WEIGHT BLOOD
(Barefoot) (Stripped) TYPE
DOCTOR 52 ft 57 kg A

AGENCY DATE EXAMINED

Bukidnon Provincial Hospital - Maramag JANUARY 2, 2017