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CSC Form No 211 (Medical-Blank)

This medical certificate form is required for original appointments and reinstatements to Philippine civil service positions. It requires a government physician to conduct a pre-employment medical examination including a blood test, urinalysis, chest X-ray, drug test, and neuropsychiatric exam if necessary. The physician must then certify on the form whether the applicant is physically and medically fit or unfit for the proposed position based on the results of the examination.

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399 views1 page

CSC Form No 211 (Medical-Blank)

This medical certificate form is required for original appointments and reinstatements to Philippine civil service positions. It requires a government physician to conduct a pre-employment medical examination including a blood test, urinalysis, chest X-ray, drug test, and neuropsychiatric exam if necessary. The physician must then certify on the form whether the applicant is physically and medically fit or unfit for the proposed position based on the results of the examination.

Uploaded by

Anonymous qg3W2rsRcG
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CSC FORM NO 211 (1997) PHILIPPINE CIVIL SERVICE

MEDICAL CERTIFICATE
For Employment

INSTRUCTIONS

1. This medical certificate should be accomplished by a government physician.


2. Attached this certificate to original appointments and reinstatements.

FOR THE PROPOSED APPOINTEE

NAME (Last, First, Middle or if married women, Maiden Name AGENCY :

ADDRESS : PROPOSED POSITION:

AGE: SEX : CIVIL STATUS :

Pre-Employment Medical Physical Tests

1. Blood Test (complete blood count & blood type)


2. Urinalysis
3. Chest X-Ray
4. Drug Test
5. Neuro Psychiatric Examination (if necessary)

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

FOR THE PHYSICIAN


BIR STAMP

I hereby certify that I personally examined the above named individual and found
her/him to be physically and medically fit/unfit for employment.

SIGNATURE OF CERTIFICATE OTHER INFORMATION ABOUT THE


PHYSICIAN : NUMBER : APPOINTEE :
BP :
Pulse Rate :

OFFICIAL DESIGNATION HEIGHT (cm) WEIGHT (kgs.)


(Barefoot) (Stripped)

AGENCY DATE EXAMINED

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