Scribd
Upload
161 views

Medical Examintation Report: Document No MTIPL/HR/F0006 1

This medical examination report documents an individual's personal information and medical history for a job application. It includes sections on past and present illnesses, measurements, vision and hearing tests, cardiovascular examination, urine and blood tests. The doctor declares the individual fit or unfit for the position and notes any specific observations. If any information provided is found to be false, the company can cancel the appointment letter or terminate employment.

Uploaded by

Kabir Shelke
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
161 views

Medical Examintation Report: Document No MTIPL/HR/F0006 1

This medical examination report documents an individual's personal information and medical history for a job application. It includes sections on past and present illnesses, measurements, vision and hearing tests, cardiovascular examination, urine and blood tests. The doctor declares the individual fit or unfit for the position and notes any specific observations. If any information provided is found to be false, the company can cancel the appointment letter or terminate employment.

Uploaded by

Kabir Shelke
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Document No Version

MEDICAL EXAMINTATION REPORT


MTIPL/HR/F0006 1

Date :

Name : Sex : Age :


Position applied for :
Married/ Unmarried : Sons : Family Planning Operation :
Daughters : Tubectomy/ Vasectomy :
I declare that the particulars given below are true, complete and correct to the best of my knowledge & belief. If any of this
information is found to be false/ incorrect, the company can cancel my appointment letter or terminate my service
contract. The decision given by the Human Resources Department will be acceptable to me and will be binding on me and I
will not make any complaint regarding the same to anybody.

Signature of the candidate


(A) Past & Present Illness/ Disease :
Asthama Epilepsy High Blood Pressure Heart Disease

Diabetes T.B. Venereal Disease Skin Disease

Hospitalization History Alergies Family History

(B) Measurements Height Weight Chest Abdomen Built - Strong/ Average/ Poor

(C) Eye Vision Right Left Other diseases of eyes

Glasses
W/o Glasses

(D) Ears (Audiometry) :

(E) Cardiovascular System : B.P. Pulse

1. Urine - Alb Sugar 3. Haemogram 5. SGPT (Liver)

Investigations :

2. Screening/ X - Ray 4. Blood Group 6. Others

I declare him fit/ unfit _________________________________________________________________________________

Any specific observation _______________________________________________________________________________

_______________________________________________________________________________

Signature of Doctor

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy