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211 Medical Certificate
DFA medical form for oral exam
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: CSC FORM NO. 211 (Revised August 1988)
PHILIPPINE CIVIL SERVICE
MEDICAL CERTIFICATE
For Employment
INSTRUCTIONS
1. This medical certificate should be accomplished by a government physician.
2. Attach this certificate to original appointments and reinstatement.
FOR THE PROPOSED APPOINTEE
NAME (Last, First, Middle, or if married woman, Maiden Name)
ADDRESS
AGENCY/ADDRESS
PROPOSED POSITION
AGE
SEX
CIVIL STATUS
Pre-Employment Medical – Physical Tests
1.
2.
3.
4.
Blood Test
Urinalysis
Chest X-Ray
Drug Test
NOTE: ALL RESULTS OF EXAMINATIONS MUST BE ATTACHED TO THIS FORM.
FOR THE PHYSICIAN
I hereby certify that I have personally examined the above named individual and
found her/him to be physically fit /unfit for employment.
PRINTED NAME/SIGNATURE OF PHYSICIAN
CERTIFICATE NUMBER
AFFIX
Documentary
Stamp Here
OTHER INFORMATION ABOUT THE
PROPOSED APPOINTEE
OFFICIAL DESIGNATION
AGENCY
HEIGHT
(Bare feet)
WEIGHT
(Stripped)
DATE EXAMINED
BLOOD
Type
