OUR LADY OF LOURDES HOSPITAL San Roque, Iriga City C E R T I F I C A T I O N TO WHOM IT MAY CONCERN: This is to certify that Manolin Be;za 28 years old, male, married,and a resident of Salvacion Iriga City was brought in this institution on January 17, 2015, on or about 5:30 in the afternoon DIAGNOSIS: 1.Two (2) gunshot wounds on the chest area. OPERATION/TREATMENT 1.Removal of metal slug and suturing of the wound REMARKS: 1.Pronounced dead at 6:00 PM due Cardiac Arrest secondary to Hemorrhagic shock secondary to gunshot wounds at left anterior chest Issued upon the request of Jannie Jill Callos – Belza, spouse of the above named person for Medico-Legal purposes. Given this 18 th day of January 2015 at Our Lady of Lourdes Hospital, San Roque Iriga City HILDA N.POTENCIANO MD Attending Physicial PRC LIC# 7698
OUR LADY OF LOURDES HOSPITALSan Roque, Iriga CityC E R T I F I C
A T I O NTO WHOM IT MAY CONCERN:
This is to certify that Manolin Be;za 28 years old, male,
married, and a resident of Salvacion Iriga City was brought in this
institution on January 17, 2015, on or about 5:30 in the
afternoon
DIAGNOSIS:
1. Two (2) gunshot wounds on the chest area.
OPERATION/TREATMENT
1. Removal of metal slug and suturing of the wound
REMARKS:
1. Pronounced dead at 6:00 PM due Cardiac Arrest secondary to
Hemorrhagic shock secondary to gunshot wounds at left anterior
chestIssued upon the request of Jannie Jill Callos Belza, spouse of
the above named person for Medico-Legal purposes.
Given this 18th day of January 2015 at Our Lady of Lourdes
Hospital, San Roque Iriga City
