Certificate Of Confinement 455962

CERTIFICATE OF CONFINEMENT ______________ (Date)

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that _____________________________________, _______ years old, (Name of Patient) (Age) _____________, _____________ from ___________________________________ was examined and (Gender) (Civil Status) (Address) confined in this hospital on / from ___________________________ to __________________________

under the service of ________________________________. (Name of Physician) This certification is being issued upon request of ____________________________ for (Name of Requester) whatever purpose it may serve them.

______________________________ Attending Physician PRC Licence No.:

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PTR No.:

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