CHONG HUA HOSPITAL

CEBU CITY
PHILIPPINES

MEDICAL CERTIFICATE

30 November 2018

NAME: ANNE Y. TAYLOR SEX: F AGE: 43

ADDRESS: SAN ISIDRO, TAGBILARAN CITY, BOHOL

VITAL SIGNS:
B.P. : _____________ W.T. ______________
H.R.: _____________ H.T. ______________

PERTINENT FINDINGS:

C.V.S.: _______________________________
C/L : _______________________________

REMARKS: PATIENT SUFFERED COMATOSE, NEED SUPERVISION.

FREQUENT TRAVEL MAY CAUSE VERTIGO.

JAIME DOS PUEBLOS M.D.

Physician
Lic. No. 1234567