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Republic of the Philippines

Department of Health
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER
Baguio City
Form no.: MS-HIM-004
Health information management office
Revision no.: 1
MEDICO-LEGAL CERTIFICATE
Effectivity date: July 1, 2015

___February 5, 2019 x
Date
TO WHOM IT MAY CONCERN:

This is to certify that MARRIO R. TORRES (Male__ Female__) _23_ of age,


(Name of patient)

From No. 48 Tacay Road, Brgy. Pinsao Proper, Baguio City f


(Address)

Was examined and treated/confined in this hospital on/from ______February 5, 2019________


(Date admitted)
to ______February 5, 2019_______ for the following:
(Date discharged)

Punctured wound sec to trauma with_ z


f foreign body, (+/-) 8cm, left gluteal region s

TIME OF ARRIVAL: _______________________12:40______________ AM/PM


Brought by: __________RAMON TORRES_____ /Relationship: ____Uncle_____________
Address: No. 48 Tacay Road, Brgy. Pinsao Proper, Baguio City x

Treatment will take from Six (6) to Nine (9) days for the above conditions/ injuries to
heal/recover unless complications will arise.

PROVISIONAL
FINAL
DY LIM, MD
Licence No. 214412
Department of ORL-HNS
Attending Physician / Medico-legal Officer