Medical Certificate For Pwd Philippines Form PDF Details

In the Philippines, individuals with disabilities are provided with a form known as the Medical Certificate for Persons with Disabilities (PWD), a crucial document that affirms the nature and extent of a person's disability. Issued by healthcare institutions equipped to evaluate and confirm such conditions, this certificate outlines specific details about the individual's disability, including the type and severity, and it plays a pivotal role in facilitating access to the rights and privileges earmarked for disabled persons under the law. The process involves a comprehensive evaluation, duly noted in the certificate, such as the identification of the disability category—ranging from locomotor or cerebral palsy to blindness, low vision, and hearing impairment—alongside the assessment of the disability's progression and its impact on the individual's physical capabilities. Recommendations regarding the reassessment of the condition are also included, providing a clear guide on how the disability may affect the individual’s daily activities and what accommodations may be necessary for their full participation in society. The certification process, underpinned by the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act 1995 and its 1996 rules, requires the formation of a Medical Board, ensuring that each case is evaluated by specialists. Through this certificate, not only is the person’s condition formally recognized, but a path is also created for them to receive the necessary support and opportunities to lead a fulfilling life, marking the document as a key instrument in the empowerment of persons with disabilities in the Philippines.

QuestionAnswer
Form NameMedical Certificate For Pwd Philippines Form
Form Length5 pages
Fillable?Yes
Fillable fields117
Avg. time to fill out24 min 43 sec
Other nameshow to get pwd certificate, certificate of disability, certification of disability form, disability medical certificate form

Form Preview Example

ANNEXURE-9

 

 

FORM OF MEDICAL CERTIFICATE FOR PERSONS WITH DISABILITIES(PWD)

 

 

 

NAME & ADDRESS OF THE INSTITUE/HOSPITAL

 

Certificate No

 

 

 

Date:

1.

This is certified that Shri/Smt./Kum*

DISABILITY CERTIFICATE

 

 

 

Paste here your recent colour

 

 

Son/Daughter* of Shri

 

 

 

 

 

 

photograph showing the

 

age

.................................sex Male/Female having identification marks as below

 

disability.

 

..........................................................................................................................................................

 

(The photograph should be

 

is suffering from permanent disability of following category:

 

attested by the Chairperson of

A

Locomotor or cerebral paisy :

 

 

 

 

 

 

the Medical Board.

 

(i)

BL-Both legs affected but not arms.

 

 

 

 

 

 

 

(ii)

BA-Both arms affected

(a)

Impaired reach

 

 

 

 

(b)

Weakness of grip

 

 

(iii) OL-One leg affected

(a)

Impaired reach

 

 

 

(right or left)

(b)

Weakness of grip

 

 

 

 

(c)

Ataxic

 

 

(iv) OA-One arm affected

(a)

Impaired reach

 

 

 

 

(right or left)

(b)

Weakness of grip

 

(c)Ataxic

(v)BH-Stiff back and hips(cannot sit or stood)

 

(vi) MW- Muscular weakness and limited physical endurance.

Signature of candidate in the above

 

 

 

 

 

box below the photograph

B.

Blindness or Low Vision :

C. Hearing Impairment :

 

 

(i)

B-Blind

(i)

D- Deaf

 

 

(ii)

PB-Partially Blind

(ii)

PD- Partially Deaf

 

 

 

 

 

(Delete the category whichever is not applicable)

2.This condition is progressive/non-progressive/likely to improve/not likely to improve. Re-assessment of this case is not

 

recommended/ is recommended after a period of

.............................years

months.

3.

Percentage of disability in his/her case is

percent.

 

4.

Sh./Smt./Kum.*

meets the following physical requirement for discharge of his/her duties:

(i)

F-can perform work by manipulating with fingers.

Yes

(ii)

PP- can perform work by pulling and pushing.

Yes

(iii) L-can perform work by lifting.

Yes

(iv) KC-can perform work by kneeling and crouching.

Yes

(v)

B-can perform work by bending.

Yes

(vi) S-can perform work by sitting.

Yes

(vii)ST-can perform work by standing.

Yes

(viii)W-can perform work by walking.

Yes

(ix) SE-can perform work by seeing.

Yes

(x)

H- can perform work by hearing/speaking.

Yes

(xi) RW-can perform work by reading and writing.

Yes

No

No

No

No

No

No

No

No

No

No

No

(Signature of Doctor)

(Signature of Doctor)

(Signature of Doctor)

Name:

Name:

Name:

Registration No :

Registration No :

Registration No :

Member, Medical Board

Member, Medical Board

Member/Chairperson, Medical Board

*Please delete the words which are not applicable.

 

 

Place :

 

 

Date:Countersignature of the Medical Superintendent/CMO/Head of Hospital(with seal)

Note-(i) According to the Persons with Disabilities(Equal Opportunities, Protection of Rights and Full Participation) Rules, 1996 notified on 31.12.1996 by the Central Government in exercise of the powers conferred by sub-section(1) and(2) of Section 73 of the Persons with Disabilities(Equal Opportunities, Protection of Rights and Full Participation) Act, 1995(1 of 1996), authorities to give disability Certificate will be a Medical Board duly constituted by the Central or State Government. The State government may constitute a Medical Board consisting of at least three members out of which at least one shall be a specialist in the particular field for assessing locomotor/hearing and speech disability, mental retardation and leprosy cured, as the case may be.

(ii) The certificate would be valid for a period of 5 years for those whose disability is temporary. For those who acquired permanent disability, the validity can be shown as 'permanent'

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