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Republic of the Philippines

Department of Social Welfare and Development


Department of Health

________________________________________________
Name of Health Facility

________________________________________________
Location

PANTAWID PAMILYANG PILIPINO PROGRAM


HEALTH CERTIFICATE

This is to certify that ______________________ ______ ____________________ has


First Name MI Last Name

record in our facility for the year 2019. Further, this is to certify that her last menstrual period is
on .
Date / Month / Year

This certification is issued for the purpose of updating of health facility of the said Pantawid
Pamilyang Pilipino Program beneficiary. Given on the ________ day of __________ 2019.
Date Month

I hereby certify the correct and authenticity of this certificate based on my records.

_________________________________________
Signature over Printed Name / Position
(Midwife / Nurse / Doctor)

Republic of the Philippines


Department of Social Welfare and Development
Department of Health

________________________________________________
Name of Health Facility

________________________________________________
Location

PANTAWID PAMILYANG PILIPINO PROGRAM


HEALTH CERTIFICATE

This is to certify that ______________________ ______ ____________________ has


First Name MI Last Name

record in our facility for the year 2019. Further, this is to certify that her last menstrual period is
on .
Date / Month / Year

This certification is issued for the purpose of updating of health facility of the said Pantawid
Pamilyang Pilipino Program beneficiary. Given on the ________ day of __________ 2019.
Date Month

I hereby certify the correct and authenticity of this certificate based on my records.

_________________________________________
Signature over Printed Name / Position
(Midwife / Nurse / Doctor)

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