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Philippine Academy of Family Physicians, Inc.

Commission on Specialty Board of Examiners

PRIMER FOR EXAMINEES

2019 Diplomate Board Examinations

Prepared by

Commission on Specialty Board of Examinations in Family Medicine

The Certifying Examinations for the title of Diplomate in Family Medicine are administered
yearly by the Commission on Specialty Board of Examiners of the Philippine Academy of Family
Physicians.
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ELIGIBILITY REQUIREMENTS

Those qualified to take the diplomate exams upon the recommendation of the Committee on
MEMBERSHIP are the following:

CME Track:
a Conferred as a certified family physician (CFP)
b. Earned 180 CME/CPD units
c. Quality Assurance Workshop Certificate*
d. Endorsement from Chapter President (see appendix)

Residency Training Track:

a Conferred as a certified family physician (CFP)
b. Earned 60 CME/CPD units per year
c. Quality Assurance Workshop Certificate*
d. Endorsement from Chairman and Training Officer (see appendix)

*If QA workshop will be held after the application period, a photocopy of the official
receipt for registration fee should be enclosed. Test results will only be released upon
submission of the QA certificate.

Other Requirements
a. Paid the examination fees
b. Settled all payable accounts to PAFP (e.g. Membership, Convention,
Assessment fees etc.)
c. Signed the consent to agree and abide by the policies and procedures of the
Examination
d. Refresher course certificate of completion for those whose 3-year validity has
lapsed.**

**If Refresher course will be held after the application period, a photocopy of the
official receipt for registration fee should be enclosed. Test results will only be
released upon submission of the Refresher course certificate.

ORIENTATION DATES & VENUES

 There will be NO orientation for the Written Examination. All the information can be
found in this primer. The primer will also be emailed to all eligible test takers and can be
accessed in the PAFP website. Should an examinee have any questions, he/she can call
the PAFP Office (Tel. No. 5162900)
Contact Persons: Ms. Ma. Helen Besmonte 0915-925130, email helen@thepafp.org
Dr. Polly T. Chua-Chan at ptchuachanmd@yahoo.com

 Orientation for the Oral Examination (2 options, attendance to at least one is required):
1. Immediately after the Written Examination (same day, October 20, 2019)
2. Day of the Oral Examination (December 7, 2019, 1 hour before OSCE, UST)

EXAMINATION DATES

 Written Examination:
Date & Time: October 20, 2019, Sunday
Registration: 8:00 am - 8:45 am
Instructions: 8:45 am
PART I: 9:00 am – 12:00 pm
PART II 1:00 pm – 4:00 pm
Venue: UST Medicine Building, exact room(s) to be posted at the building
entrance
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 Oral Examination:

Date & Time: December 7-8, 2019, Saturday & Sunday, 8:00- 5:00 pm

Day 1: Seven (7) Focused OSCE Stations + 1 rest station

Venue: 3/F UST Medicine Building, exact room(s) to be announced
Tentative testing rooms: Histology (3/F), Neuroanatomy (3/F) and
Biochemistry (2/F). Room assignments will be posted at the
bulletin board, beside Room 329, 3rd floor on the morning of the
testing day.

Day 2: Seven (7) Integrated Case OSCE stations + 1 rest station

Venue: Assigned rooms at the UST Medicine Building

 In case of extreme weather conditions affecting the testing venues, the examination
dates will automatically be moved to the following week with the same schedule of days
in the week and set time, unless otherwise specified.

 Follow us and watch out for announcements at our Facebook page “PAFP Specialty
Board Exams”

APPLICATION PROCEDURES & REQUIREMENTS

 The PAFP Secretariat and the Commission and the Committee on Membership will
perform the proper notification and coordination with those qualified to take the written
exam not later than August 30, 2019, FRIDAY.

 All applications for written, oral exams or both should be coursed through the PAFP
Secretariat not later than the designated DEADLINES.
Written examination: September 20, 2019, Friday
Oral examination: November 4, 2019, Monday

 Application Requirements:
1) Filled up application form
2) 3 pcs 2x2 most recent colored ID picture with white background labeled and
signed at the back. (2 photos pasted on the test permits)
3) Application fee of Php 7,000.00 for both examinations; - Php 3,000.00 for written
exam only and Php 4,000.00 for oral exam only
4) Signed consent forms agreeing to the policies and procedures of the Examination
5) Submit the filled up Test Permits for encoding of Examinee Number. Permits will
be claimed at the testing venue on the day of the examinations.
6) Endorsement letter from respective Training Officer and Chairman of the Training
Program; or the Chapter President for CME track. (See appendix)
7) Photocopy of Certificate of Attendance in PAFP Quality Assurance Workshop
8) Photocopy of the Certificate of Completion in Refresher course (only for those
required)

 Submission of the above-mentioned requirements can be done by:

 Hand delivery to PAFP Office
 Delivered by courier to PAFP Office with address 2244 Taft Avenue, Malate, Manila
1004 Philippines. Attention: Commission on Specialty Board of Examiners
 For other concerns: Call PAFP Office (632) 5162900; 0908-8666124; 09328528743
Contact Person: Ms. Ma. Helen Besmonte 0915-925130, email helen@thepafp.org
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I. THE WRITTEN EXAMINATION

The written examination intends to assess the examinee’s ability to apply, analyze and
synthesize acquired knowledge in clinical and family medicine in order to be considered as a
competent family physician after years of training and practice.

A. CONTENT OF THE WRITTEN EXAMINATION

The written examination consists of three hundred (300) multiple choice questions
(MCQs) selecting the single best answer (SBA). It is divided into two (2) sets of 150. Each set
is allotted 2.5 hours to complete (5 hours for the entire exam). The topics are mainly based on
the latest Manual of competencies as well as the Summary of Cases and Procedures included
in the resident’s learning portfolio.

1. Clinical Medicine: Child, Adult & Elderly Care across different clinical settings
(70% - 210 questions)
2. Non-Clinical Foundation Courses: (30% - 90 questions)

B. GENERAL BLUEPRINT FOR THE WRITTEN EXAMINATION

The number of questions and percent distribution per discipline or system (CLINICAL
MEDICINE topics) are shown below. All items will test application, analysis and synthesis
of knowledge required for problem solving and identifying causes and evidences to support
generalizations.

The examination may include pictures or illustrations of disease manifestations (ex.

skin lesions, fundoscopic findings, etc) and clinic and ancillary procedures (ex. medical imaging,
ECG, etc.).

Example:
A 22 year old man has an acute, painful, red right eye with blurring of vision for one day. He had
a similar episode one year ago and has had episodic back pain and stiffness relieved by
exercise and diclofenac for four years. What is the most likely cause of his red eye?
A Chorioretinitis
B Conjunctivitis
C Episcleritis
D Iritis
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BLUEPRINT FOR THE WRITTEN EXAMINATION

CLINICAL Percentage OPD In-Patient ER Allotted

Areas Distribution No. of Questions
Across age groups 70% 70% 15% 15%

Cardiology 10% 15 3 3 21
Endocrine/ 10% 15 3 3 21
Metabolic
GIT/ Nutrition 10% 15 3 3 21
GUT/ 10% 15 3 3 21
Reproductive
Infectious Diseases 10% 15 3 3 21
Neurology/ 10% 15 3 3 21
Musculoskeletal
Respiratory 10% 15 3 3 21
EENT 5% 7 2 2 11
Dermatology 5% 7 1 2 10
Mental Health/ 5% 7 2 2 11
Developmental
Occupational / 5% 7 2 1 10
School Health
Oncology/ 5% 7 1 2 10
Palliative Care
Hematology/ 5% 7 2 2 11
Immunology
147 31 32
TOTAL 100% 210

NON-CLINICAL 30% No. of Questions

Areas
Family 70% 63
Psychodynamics &
Principles (30 )
Wellness (25)
Ethics (5)
Research/EBM 20% 18
Community 10% 9
(Leader, Advocate)
TOTAL 100% 90
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The MUST-KNOW topics can be found in the Summary of Cases and Procedures
provided by the Residency Committee (see PAFP website, Residency Corner). Examples
are the following common conditions but may not be limited to:

Respiratory Cardio Hematology/Immunology

Pneumonia, Bronchitis Hypertension Anemias
COPD Coronary Artery Disease Leukemias
Asthma Heart Failure Hypersensitivity
PTB Congenital Heart/ RHD Anaphylaxis
Endocrine/Metabolic GUT/Nephro Reproductive
Diabetes UTI, Pyelonephritis Abnormal uterine bleeding
Thyroid Diseases Urolithiasis Myoma uteri
Dyslipidemia Kidney Disease Pregnancy and complications
Obesity Glomerulonephritis Sexually Transmitted Infections
Nutritional Deficiencies BPH Women and Men’s Health
Oncology/Palliative Gastro Infectious
Cervical cancer Dyspepsia, GERD Malaria, Filaria, Schistosomiasis
Breast cancer Ulcers Dengue, other hemorrhagic fevers
Colorectal Cancer Acute Appendicitis Hepatitis
Liver Cancer Bowel Obstruction Measles, other Viral exanthems
Kidney, prostate cancer Acute Cholecystitis/Lithiasis Typhoid, Amebiasis
Wilms, Retinoblastoma Pancreatitis Infectious diarrhea
Osteosarcoma Malnutrition Meningitis, Mumps
Control of Constipation Influenza, influenza-like illnesses
terminal symptoms Chronic Diarrhea Emerging diseases
Neurology Occupational/School Health Mental Health/Developmental
Stroke Bullying ADHD, Autism
Headache Occupational violence Down’s syndrome
Insomnia Poisoning: Salicylates, alkalis Depression, mood disorders
Dementia Acids, INH, Pesticides (OP) Anxiety Disorders
Seizure Preventive recommendations Insomnia
Syncope Environmental hazards and Alcohol dependency
Febrile Convulsions Effects Addictions
Musculoskeletal
Dermatology EENT Others: FM Principles related to
Impetigo BPPV the different roles of a FP:
Allergic dermatitis Conjunctivitis, Healer
Seborrheic dermatitis Differentials of Red Eye Communicator/ Counselor
Acne, Miliaria Error of refraction Researcher /Lifelong Learner
Pediculosis, Scabies Glaucoma, Cataract Leader/Manager
Carbuncle, Furuncle Blepharitis, Hordeolum Community Advocate/
Decubitus ulcers Impacted cerumen Social Mobilizer
Insect bites, Urticaria TMJ Dysfunction
Pityriasis rosea Pharyngitis, LPR Also included:
Burns Hearing Loss Preventive care
Fungal infections Otitis Media, externa Concepts of the Foundation
Skin manifestations of Allergic rhinitis courses
Systemic diseases Meniere’s

The agreed major references to be used for the 2019 Specialty Board Examinations are:
a. CLINICAL: Latest known CPGs (international and local) – links are available at the
Residency Corner of the PAFP website.
Link to the compendium: http://www.thefilipinodoctor.com/cpm_pdf/
b. NON-CLINICAL: Leopando et al, Textbook of Family Medicine Volume 1 (Principles,
Concepts, Practice and Context) and Volume 2 (Enhancing the Performance of the Five Star
Family Physician)
c. Rakel’s Textbook in Family Medicine, 9th edition -- for FM principles
d. Dr. Eva Irene Maglonzo, Geriatrics and Filipino Family Physician Today 2nd edition –
e. Filipino Family Physician Journal (last 2 and 1st issue of the previous and current year,
respectively)
f. Family-Oriented Medical Care, 2nd Edition by Susan H. McDaniel
C. CONDUCT OF THE WRITTEN EXAMINATION
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1. Qualified examinees should submit the complete requirements to the PAFP Office on or
before the deadline set by the PAFP secretariat.

2. All examinees must be in proper attire: Smart casual. No shorts, no mini-skirts, no

plunging necklines, no slippers will be allowed. Bring sweater or jacket.

3. At the venue, register in the assigned room one hour prior to the start of the examination.
The examinee must present a valid government ID (PRC card, Driver’s License,
Passport) to claim their TEST PERMIT.

4. Pencil with eraser (Mongol No.2) will be provided at the testing venue. Sharpeners will
also be available. No pencil case, erasers, pens, calculators and the like will be allowed.

5. Seats for the candidates are pre-numbered as indicated on the test permit. No change in
seating arrangement is allowed unless authorized by the examiners.

6. All personal belongings including mobile phones, wrist watch, and unnecessary
accessories must be kept in your bags, and stored in the front area of the room. Cellular
phones should be turned off. A big clock will be displayed in the testing rooms.

7. Examinee answer sheets (EAS) will be machine validated. Write your assigned
Examinee Number on the EAS. Do not write your name. Refer to the appendix of this
primer for familiarization and practice purposes.

8. No identifying marks shall be placed on the EAS. Markings can be made on the
questionnaires.

9. Make sure that questionnaires have the complete number of pages.

10. Only Mongol Pencil No. 2 should be used. Shading should not be too light nor too
heavy. Avoid erasures as this may cause machine validation issues.

11. There will be a one-hour lunch break from 12 to 1 pm. Packed lunch will be served.
Those with special diets (vegan, vegetarian, halal etc.) can indicate in their application
form and/or coordinate with PAFP secretariat.

12. Make sure that you occupy the same seat number in Part 2.

13. Examinees are allowed to leave the room only for personal necessities and shall be
accompanied by a proctor.

14. Any attempt to communicate with a co-examinee while the examination is ongoing is
presumed cheating. Any concern should be directed to the proctor.

15. All test permits will be collected and surrendered at the registration table at the end of the
exam.

*Please always check FB page “PAFP Specialty Board Exams 2019” for updates
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II. THE ORAL EXAMINATIONS

The Objective Structured Clinical Examination (OSCE) aims to evaluate the skills and
behavior of the examinee in situations which reflect the competencies of a Family Physician in
clinical settings. The oral examination is focused on the performance of required tasks and
procedures needed to be a health care provider, educator, counselor, manager, and social
mobilizer, whenever possible.

Depending on the number of examinees, two or 3 sets of OSCE stations will be

conducted simultaneously in 2 or 3 separate rooms. The examinees will be grouped in advance
according to the rules set by the Specialty Board. Most if not all stations will utilize simulated
patients. Each station will take ten (10) minutes: 2 minutes to read the case prior to entering
the cubicle, then eight (8) minutes to perform the task(s) at hand.

Day 1: Seven (7) Focused (F) OSCE Stations + 1 rest station

Station F1: Focused Clinical History Taking

Station F2 & F3: Procedural Skills
Station F4 & F5: Clinical Management Decision Skills
Station F6 & F7: Family Management and Interventions
Station 8: Rest station

Day 2: Seven (7) Integrated (I) Case OSCE stations + 1 rest station

Stations I1 to I7: Integrated cases: Representative clinical scenarios encountered

in actual practice
Station 8: Rest station

Example of an Integrated Case:

Your patient, Tim Horton, aged 45, comes in because of pain in his right big
toe. You are not given any other information. You must assess and manage
the patient. You have eight minutes.

A. CONDUCT OF THE OSCE

1. All examinees must be in proper attire: Comfortable smart casual attire and comfortable
shoes. No shorts, no mini-skirts, no slippers will be allowed. Blazers and sweaters may
come in handy.

2. The examinee must present their TEST PERMIT and a valid government ID (PRC card,
Driver’s License, Passport etc.) as the assigned testing room. Sticker IDs will be
provided for each examinee.

3. Examinees should report to their assigned rooms at least 60 minutes before the start of
the examination. Stay in the designated holding areas where further division into
subgroups will be done to determine the sequence in taking the examination.

4. All personal belongings including mobile phones, wrist watch, and unnecessary
accessories must be kept in your bags, and stored in a designated space of the holding
area. Cellular phones should be turned off. A timekeeper will be assigned per testing
room.

5. Medical references and other reading materials are NOT allowed in the holding area.

6. Toilet break is only allowed while the examinee is in the holding area.

7. The examinee will find a series of rooms known as ‘stations’. There will be seven (7)
stations on Days 1 & 2. Stations are manned by an examiner with simulated patients /
actors. Each station requires the examinee to undertake a set of tasks. The examinee is
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expected to perform all the tasks as instructed and shall be graded accordingly using a
rating scale.

8. A group of 8 examinees according to the master list will comprise one batch or cycle.
Each examinee will be assigned a station, including a rest station. Hence, one may not
begin with Station 1, but the flow of movement from station to station will be consecutive
(e.g. Station 2  Station 3  Station 4 etc)

9. Before entering a station, the examinee will sit on the “waiting” chair. Here, the
examinee has two (2) minutes to read the case and, compose his/her thoughts. Notes
can be written on the scratch papers provided attached to the testing permit. Another
copy of the case and instructions will also be available inside the station.

10. At the end of the 2-minute period, a bell will ring to signal the examinee to enter the
station proper. Read the case and tasks again if necessary. Perform the tasks required
within eight (8) minutes. A rating scale will be used to evaluate the performance of the
examinee in each station. Questions can only be directed to the examiner if specifically
stated in the instructions or when deemed necessary.

11. The bell will ring at the end of 8 minutes to signal the examinee to stop and exit the
station proper. At this point, the examinee should proceed to the “waiting” chair of the
next station. If the examinee finishes the tasks before 8 minutes, he/she must stay put
inside the station proper. Casual conversation with the examiner or the patient during this
time is not allowed.

12. The examinee should continue in this manner until all the stations have been completed.
The OSCE is then considered finished.

13. A REST station will be encountered after Station 7.

14. Any attempt to communicate with a co-examinee while they are going through the
stations is presumed cheating.

15. The examinee shall surrender the test permit (together with the scratch papers) to the
area coordinator after finishing all the OSCE stations. The examinee shall also
accomplish the feedback / evaluation form.

16. The Chair of the Specialty Board reserves the right to change any OSCE case if there is
a breach or leakage of information or to modify the process at any given time when
deemed necessary.
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III. POLICIES ON THE EXAMINATIONS

1. An eligible examinee has the option to take one (oral alone or written alone) or both exams
(written and oral) in the same year after complying with the requirements.
2. Passing the written examination is NO longer a pre-requisite for taking the Oral Examination.
3. Examinees who passed only one exam are given three (3) consecutive years to take and
pass the remaining exam.
4. Examinees who failed to pass both exams within the 3-year period will invalidate the result of
the exam that was already passed. They shall also be required to take the refresher course
offered by FaMED (Foundation of Family Medicine Educators, Inc.). The certificate of
attendance in the refresher course and compliance of the CME/CPD credit requirement are
needed to be eligible to take the exams again and subjected to the same 3-year validity
period if they pass only one exam.
5. Only those who take both exams for the first time in the same year will be eligible to be
considered as the board topnotcher.
6. After registering for the examination, the examinee agrees to abide with all the policies and
procedures stipulated in the primer and the consent form.
7. In case of failure to take the exam for no valid reasons (validity to be decided by the chair),
the examination fees shall be subject to the “no refund” and forfeiture policy. After deducting
the operational and mailing costs, 50% will be refunded if canceled within 7 days after the
deadline; and no more refund thereafter.
8. Any form of cheating or dishonesty will disqualify those found guilty. The Specialty Board
may declare a failure of the whole exam if there is massive cheating, breach or leakage of
information of the questions. In such case, another exam will be re-scheduled.
9. The Chairman of the CSBEFM shall recommend to the PAFP National Board the examinees
who have passed both written and oral within the same year or within the prescribed 3-year
period.
10. The National Board of Directors shall officially endorse the candidates for the title of
Diplomate in Family Medicine to be conferred during the Annual Convention.
11. The successful candidates will only be officially notified upon approval by the National
Board of Directors.
12. The decision of the Commission on Specialty Board and the National Board of Directors are
considered final and executory.

IV. RELEASE OF RESULTS

For a fair and just conduct of the examination process, the Board of Examiners will set a
mean passing level (MPL) and perform item analysis of the written test questions. These shall
serve as a guide to assess the validity, reliability and outcome of the examinations. For the
OSCE, an examinee should pass 10 out of the 14 stations in order to pass.
Successful examinees will be posted on the PAFP website and Facebook Page using
the Examinee Number indicated on their testing permits. Hence, it is important that the
examinee remembers and notes down his/her examinee number. Names of top 10 successful
examinees will be posted with a signed waiver of information release. Official letters indicating
the results of the exams (passed or failed) will then be sent to all examinees by the Commission
on Specialty Board. No more verbal or telephone inquiries on the results of the exams will be
entertained by the PAFP Secretariat.
A formative feedback may be given to those who did not pass the examinations only
when requested in writing and approved by the Specialty Board.

Prepared by:
Commission on Specialty Board, 2019
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PHILIPPINE ACADEMY OF FAMILY PHYSICIANS

#2244 Taft Avenue, Malate, 1004 Manila
Tel. No. 516-2900/405-0140; Tel./Fax: 254-5646
Globe: 09175486550 Smart: 09088666124 Sun: 09328528743
E-mail Address: secretariat@thepafp.org

APPLICATION FOR DIPLOMATE EXAMINATIONS

Deadline of application form and payment for Written: September 30, 2019, Monday
Deadline of application form and payment for Orals: November 8, 2019, Friday

THE CHAIR
Specialty Board of Examiners
Philippine Academy of Family Physicians

Please be informed that

 I am taking both written and oral examinations Php 7,000 Mode of Payment
 I am taking only the written examination Php 3,000  Cash
 I am taking only the oral examination Php 4,000  Cheque No.___________
 I am not taking the examination -----  Bank deposit __________
Account name: PAFP through BDO S/A No. 004580325004. After deposit has been made, please send the bank
deposit slip either by email secretariat@thepafp.org.

CONSENT

No-show during examination: In case of failure to take the exam for no valid reasons, the
examination fees shall be subject to the “no refund” and forfeiture policy. After deducting all the
operational costs (materials, mail, food reservation etc), 50% will be refunded if canceled within
seven (7) days after the set deadline of payments; and no more refund thereafter.
Article XII, Section 11: Any personal inquiry or questions regarding the results of the
examination must be made in writing addressed to the Chair within a month after receiving the
examination results; otherwise, inquiries beyond the allowed period will no longer be
entertained.
Article XII, Section 14: The decision of the CSBEFM and the National Board is final and
executory.
Article XV, Section 3: Any issue raised by an examinee regarding the conduct and results of the
examination will be evaluated by the Chair and/or members of the Specialty Board and shall try
to resolve the matter in their level. Any issue that remains unresolved will be elevated to the
PAFP National Board for final action.
Article XVI, Section 1: The Chair of the Specialty Board is the only person authorized to release
the results of the examination after the presentation to the National Board. Procedure for
dissemination shall be followed including posting of names of the top 10 examinees.
Article XVI, Section 2: Requests for results from any examinee for formative feedback purposes
only will be attended to if a written request is made within 30 days and after the Specialty Board
Officers have agreed to the request.

I have read and fully understood the implementing rules and regulations of the Specialty Board
Examinations.

Print Name and Signature: _______________________________________________

Chapter / Institution: _____________________________________________________
Mailing Address: ________________________________________________________
Home / Mobile Nos. _____________________________________________________
Email Address:_________________________________________________________
Special needs or diet / requested, if any (vegetarian, vegan, halal):__________________
PRINT ALL FORMS ON A4 SIZE. FOR STRICT COMPLIANCE
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PHILIPPINE ACADEMY OF FAMILY PHYSICIANS EXAMINEE NO. 00______

SPECIALTY BOARD EXAMINATIONS

ORAL EXAMINATION PERMIT

December 7, 2019, Sat, 9:00 am
December 8, 2019, Sun, 9:00 am PHOTO
Please arrive one hour before the examinations.
Permit to be filled up and submitted together with the application form.
It will be claimed upon registration on the day of the examination.

NAME (Surname, First, Middle Initial)______________________________________________________________

CHAPTER/TRAINING INSTITUTION: ____________________________________________________________

MAILING ADDRESS:___________________________________________________________________________

______________________________________________________________________________________________

CLINIC/HOSPITAL & ADDRESS_________________________________________________________________

TEL. NO. : ________________________MOBILE NO. _______________________________________________

PRC NO. __________________ PMA NO. ________________ E-MAIL: _________________________________

Verified by:

____________________________
Examiner

- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - - - - - - - - - -

PHILIPPINE ACADEMY OF FAMILY PHYSICIANS EXAMINEE NO. 00_______

SPECIALTY BOARD EXAMINATIONS

WRITTEN EXAMINATION PERMIT

October 20, 2019, Sunday
9:00 am to 3:00 pm PHOTO
Please arrive at least 45 minutes before the examination.
Permit to be filled up and submitted together with the application form.
It will be claimed upon registration on the day of the examination.

NAME (Surname, First, Middle Initial)______________________________________________________________

CHAPTER/TRAINING INSTITUTION: ____________________________________________________________

MAILING ADDRESS:___________________________________________________________________________

______________________________________________________________________________________________

CLINIC/HOSPITAL & ADDRESS_________________________________________________________________

TEL. NO. : ________________________MOBILE NO. _______________________________________________

PRC NO. __________________ PMA NO. ________________ E-MAIL: _________________________________

Verified by:

____________________________
Examiner

PRINT ALL FORMS ON A4 SIZE. FOR STRICT COMPLIANCE

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ENDORSEMENT FROM DEPARTMENT CHAIRMAN, TRAINING OFFICER (For Residents)

ENDORSEMENT FROM CHAPTER PRESIDENT (For CME Track)

Requirement for Taking the Specialty Board Examinations in Family Medicine

Written Examination: October 20, 2019

Oral Examinations: December 7-8, 2019

CHAIRMAN’S ENDORSEMENT
I hereby endorse the application of DR. __________________________________________

to take the written / oral diplomate examinations in Family Medicine.

Chairman (Name and Signature) _____________________________________________

Institution _________________________________________ Date ___________________

TRAINING OFFICER’S ENDORSEMENT

I hereby endorse the application of DR. __________________________________________

to take the written / oral diplomate examinations in Family Medicine.

Training Officer (Name and Signature) _________________________________________

Institution ______________________________________ Date ______________________

CHAPTER PRESIDENT’S ENDORSEMENT (For CME Track)

I hereby endorse the application of DR. __________________________________________

to take the written / oral diplomate examinations in Family Medicine.

President (Name and Signature) ______________________________________________

Chapter ________________________________________ Date ______________________

PRINT THIS FORM ON A4 SIZE. FOR STRICT COMPLIANCE

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SPECIALTY BOARD OF EXAMINERS

FISCAL YEAR 2019

Polly T. Chua-Chan, MD Marie Ruth A. Echavez, MD Vivien Fe F. Fadrilan-Camacho, MD

Chair Vice-Chair Secretary

Ellen May G. Biboso, MD Violeta C. Rendon, MD Imelda Q. Tiglao MD

Regular Regular Regular

Marocel C. Montillano, MD Mae Lynn M. Acebuque, MD Aeesha Y. Pingli, MD

Regular Regular Regular

Evelyn A. Siao-Brigino, MD Alma Sheila S. San Miguel, MD Ethelda Carmela C. Magalang, MD

Regular Regular Regular
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Dax M. Tidula, MD Andresul A. Labis, MD Djhoanna Aguirre-Pedro, MD

Regular Regular Regular

Kenneth Niño T. Alcoseba, MD Maria Nerissa D. Gonzales, MD Jessica T. Lorejo, MD

Associate Associate Associate

Rowena Marie Tulang-Samares, MD Haydee D. Danganan, MD Daisy Medina, MD

Associate Associate Associate