Filetype Word DOC | Posted on 08 Aug 2022 | 4 years ago
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MEDICAL CERTIFICATE
in Case of Hospitalization
(To be filled up by attending physician)
NAME OF PATIENT: ______________________________________
PERIOD OF CONFINEMENT: ______________________________________
(Inclusive Dates)
PHYSICIAN’S REMARKS:
(Final Diagnosis / Surgical Operation or Any Medical Procedure Performed)
I HEREBY CERTIFY that the foregoing answers are true, correct and complete.
_________________________________ _______________ ______________
Printed Name & Signature License No. Date
of Attending Physician
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