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Physical Examination Report: Philippine National Police Health Service

1) This document is a physical examination report form used by the Philippine National Police Health Service. It contains sections to record a subject's personal information, medical history, physical evaluation findings, and laboratory test results. 2) The physical evaluation involves checking over 25 items related to different body systems and functions for normality or abnormalities. Additional testing may include chest x-rays, ECGs, blood tests and more. 3) At the end, the examining medical officer provides a physical profile, summary of any defects, recommendations on fitness for police service, and certifies the examination.

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2K views2 pages

Physical Examination Report: Philippine National Police Health Service

1) This document is a physical examination report form used by the Philippine National Police Health Service. It contains sections to record a subject's personal information, medical history, physical evaluation findings, and laboratory test results. 2) The physical evaluation involves checking over 25 items related to different body systems and functions for normality or abnormalities. Additional testing may include chest x-rays, ECGs, blood tests and more. 3) At the end, the examining medical officer provides a physical profile, summary of any defects, recommendations on fitness for police service, and certifies the examination.

Uploaded by

lara michelle
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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PNP HS MS FORM NO.

2014-02 Revised 2017

Republic of the Philippines


National Police Commission
PHILIPPINE NATIONAL POLICE
HEALTH SERVICE
Camp PBGen Rafael T Crame, Quezon City

PHYSICAL EXAMINATION REPORT


DATE: _______________________ CONTROL NO. - - - - - - - - - - -
RANK LAST NAME FIRST NAME MIDDLE NAME AGE SEX CIVIL STATUS
Mulok Saadodin Macabalang
PERMANENT HOME ADDRESS (NUMBER,STREET,CITY OR TOWN PROVINCE) CONTACT NUMBER

BADGE NO. DATE OF BIRTH PLACE OF BIRTH RELIGION PURPOSE OF EXAMINATION

LENGTH OF SERVICE UNIT ASSIGNMENT/ADDRESS

NEXT OF KIN (NAME, RELATIONSHIP, ADDRESS, CONTACT NO.)

THIS PART IS TO BE FILLED-UP BY MEDICAL STAFF/MEDICAL OFFICER


HEIGHT (cm) barefoot WEIGHt (kg) stripped COLOR OF HAIR COLOR OF EYES WAIST CIRCUMFERENCE BMI (weight in kg / height in meter
squared):

BLOOD PRESSURE (mmHg) HEART RATE (bpm) RESPIRATORY


DATE DATE DATE DATE DATE DATE
RATE (cpm)

1ST 2nd 3 rd 1ST 2nd 3 rd TEMP (°C)

NOTE: Describe every abnormality in detail. Enter number of pertinent item,


PHYSICAL EVALUATION before each comment. Use additional sheet if necessary.
EXAMINER’S
Check each item in appropriate column. NORMAL ABNORMAL
INITIALS
1. SKIN,LYMPHATICS
(identifying body marks, scars & tattoos)
2. HEAD,FACE, AND SCALP
3. NECK (mass, lymph nodes)
4. NOSE
5. MOUTH AND THROAT
6. EARS-GENERAL (int. & ext)
7. EAR DRUMS (perforation)
8. HEARING (WHISPER VOICE TEST)
RIGHT WV ____ / 15 LEFT WV ____ / 15
9. EYES (general appearance)
10. PUPILS (size, reactions), VISUAL FIELD
11. OCULAR MOTILITY (EOM)
12. DISTANT VISION
RIGHT __ - - /__ PINHOLE __/__
LEFT __/__ PINHOLE __/__
13. NEAR VISION
RIGHT J _____ LEFT J _____
14. COLOR VISION (ISHIHARA)
15. LUNGS AND CHEST (include breasts)
16. HEART (PMI, rhythm, murmur)
17. PERIPHERAL VASCULAR (varicosities)
18. ABDOMEN (note for hernia)
Page 1 of 2
20.2CY.0000495.BAR
19. ANUS AND RECTUM
20. GENITALIA
21. UPPER EXTREMITIES (strength, range of motion)
22. LOWER EXTREMITIES(strength, range of motion)
23. SPINE, MUSCULOSKELETAL
24. NEUROLOGIC
FEMALES ONLY (check how done) 26. OBSTETRIC SCORE
G___ P ___ (__ __ __ __) ( ) NSD ( ) C/S
25. PELVIC
( ) VAGINAL ( ) RECTAL LMP ________________ ( ) ABORTION

CHEST X-RAY, ECG, AND LABORATORY EXAMINATION


CXRAY (PLACE, DATE, FILM NUMBER, RESULT) ECG (PLACE, DATE, INTERPRETATION)

HEMATOLOGY URINALYSIS BLOOD CHEMISTRY SEROLOGY


COMPLETE BLOOD COUNT FBS RPR / VDRL

CREA HBs Ag

OTHERS: ANTI-HBS
PREGNANCY TEST
ABO & RH BLOOD TYPE

OTHER TESTS/ANCILLARY PROCEDURES:

ADDITIONAL CLINICAL NOTES: PHYSICAL PROFILE SUFFIX


P U L H E S R T D O

SUMMARY OF DEFECTS NOTED/DIAGNOSIS (basis for disqualification):

RECOMMENDATIONS: PHYSICAL HEALTH


 PHYSICALLY FIT FOR POLICE SERVICE PROFILE
 FIT FOR POLICE SERVICE BUT WITH RESTRICTIONS, specify;_________________________
 TEMPORARILY UNFIT FOR POLICE SERVICE FOR ___________ MONTHS
 PERMANENTLY UNFIT FOR POLICE SERVICE

I hereby certify that I have seen and thoroughly examined this applicant together with his/her laboratory
results that lead to the above recommendation/s.

__________________________________ _____________________
SIGNATURE OVER PRINTED NAME DATE EVALUATED
MEDICAL OFFICER
Page 2 of 2
20.2CY.0000495.BAR

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