Medical Exaqmination Form
Medical Exaqmination Form
Medical Exaqmination Form
NAME: RICARDO DELOS REYES SR. AGE: 52 years old SEX: Male CIVIL STATUS: Married
ALLEGE DATE /TIME AND PLACE OF INFLICTION: On or about 9:30 AM, February 12, 2017
along Campomanes Street, Brgy. 14, CAN AVID, Eastern Samar
FINDINGS:
CONCLUSION:
1) Above physical injuries are found in the body of the subject the age of which is
compatible to the allege date of infliction.
2) Under normal condition without subsequent complication and or deeper
involvement is present but not clinically apparent at the time of examination the
above physical injuries will require medical attention or will incapacitate the
victim for a period not less than ______ days but not more than ______ days.
REMARKS:
NAME: LINDA CATUDAY y MORALLOS AGE: 61 years old SEX: Female CIVIL STATUS:Married
ALLEGE DATE /TIME AND PLACE OF INFLICTION: On or about 2:00 PM, January 16, 2017 along
South Bound Lane of National Highway, Brgy. Malaintos, Dolores, Eastern Samar
FINDINGS:
CONCLUSION:
3) Above physical injuries are found in the body of the subject the age of which is
compatible to the allege date of infliction.
4) Under normal condition without subsequent complication and or deeper
involvement is present but not clinically apparent at the time of examination the
above physical injuries will require medical attention or will incapacitate the
victim for a period not less than ______ days but not more than ______ days.
REMARKS: