MEDICAL EXAMINATION CERTIFICATE

Email Id:*

Phone No: *

Name: *

Father's Name : *

Address: *

Gender: *

Male

Female

Course: *

Weight:

Height:

Blood Group:

Rh Factor:

Family History:

Previous History:

Blood Pressure:

Hearing:

Abdomen:

Teeth:

Throat:

Lungs:

Eye-Sight:

Right:

Left:

Urine:

Reaction:

Albumin:

Sugar:

Microscopic:

Blood Examination:

Haemoglobin
WBC
Platelet
RBC
Chest X-Ray
Menstrual History (if applicable): Regular / Irregular

Date:

Signature and Stamp of the Medical officer