Supercare Medical Services, Inc. Health Declaration Form: Remarks of Examining Physician
Supercare Medical Services, Inc. Health Declaration Form: Remarks of Examining Physician
Supercare Medical Services, Inc. Health Declaration Form: Remarks of Examining Physician
As part of our precautionary measures to prevent the spread of COVID - 19, please answer truthfully the questions below.
Giving of false or erroneous information or answer is a crime punishable under existing law
I hereby authorize SuperCare Medical Services, Inc. to collect and process the data indicated herein for the
purpose of effecting control of the COVID-19 infection. I understand that my personal information is Remarks of Examining Physician:
Protected by RA 10173, Data Privacy Act of 2012, and that I am required by RA 11469, Bayanihan to Heal as
One Act, to provide truthful information.