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CSC Form 211 - Medical Certificate PDF

This document is a medical certificate form for employment in the Philippine civil service. It requires a government physician to conduct various medical tests, including blood tests, urinalysis, chest x-rays, and drug tests, and a neuro-psychiatric exam if necessary. The physician must then certify whether the applicant is physically and mentally fit for the proposed position based on the results of the examinations.

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3K views1 page

CSC Form 211 - Medical Certificate PDF

This document is a medical certificate form for employment in the Philippine civil service. It requires a government physician to conduct various medical tests, including blood tests, urinalysis, chest x-rays, and drug tests, and a neuro-psychiatric exam if necessary. The physician must then certify whether the applicant is physically and mentally fit for the proposed position based on the results of the examinations.

Uploaded by

LuvyJohnFlores
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

PHILIPPINE CIVIL SERVICE

CSC Form No. 211 (Revised August 1998)


MEDICAL CERTIFICATE
For Employment
INSTRUCTIONS
1. This medical certificate should be accomplished by the government physician.
2. Attach this certificate to original appointments and reinstatements.

FOR THE PROPOSED APPOINTEE


NAME (Last, First, Middle or if married woman, Maiden Name

AGENCY/ADDRESS

ADDRESS
PROPOSED POSITION
AGE

SEX

CIVIL STATUS

Pre-Employment Medical-Physical Test


1.
2.
3.
4.
5.

Blood Test
Urinalysis
Chest X-ray
Drug Test
Neuro-Psychiatric Examination Result (if necessary)

NOTE: ALL RESULTS OF EXAMINATIONS MUST BE ATTACHED TO THIS FORM.

FOR THE PHYSICIAN

I hereby certify that I personally examined the above-named individual


and found her/him to be physically and mentally fit for employment.

PRINTED NAME/SIGNATURE OF PHYSICIAN

Documentary
Stamp

CERTIFICATE NUMBER
OTHER INFORMATION ABOUT THE
PROPOSED APPOINTEE

OFFICIAL DESIGNATION

HEIGHT

AGENCY

DATE EXAMINED

WEIGHT
(stripped)

BLOOD
TYPE

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