Medical Certificate For Pwd Philippines Form PDF Details

Are you looking for a comprehensive guide on how to obtain a medical certificate for PWD Philippines? Look no further! In this article, we will provide step-by-step instructions to help make the process as simple and straightforward as possible. We'll share with you all the necessary documents required, information on where to apply, important dates and more. Whether you are applying yourself or helping someone else get a medical certificate of disability in the Philippines, this post provides an overview of what is needed so that you can receive your certification as smoothly as possible. Read on to learn how to successfully secure a medical certificate of disability in one of the most efficient ways available today!

QuestionAnswer
Form NameMedical Certificate For Pwd Philippines Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdisability medical certificate form, how to get pwd certificate, certificate of disability, pwd medical certificate

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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