Free Essay

A Study on Pemt

In: Business and Management

Submitted By bangiavinash
Words 421
Pages 2
MEDICAL EXAMINATION

1. PERSONAL DETAILS:

Name:_______________________ Surname__________________________ Age____________

Address:_______________________________________________________________________

Martial Status________________ Sex_________

2. FAMILY HISTORY

| |AGE |HEALTH(GOOD, BAD, FAIR) |AGE AT DEATH |IF DEAD |
|Father | | | | |
|Mother | | | | |
|Brother (NO) | | | | |
|Sisters (NO) | | | | |
|Husband/Wife | | | | |
|Children (NO) | | | | |

3. PERSONAL HISTORY:(Self Declaration)
Are you in good health and capable of full work________________________________________
Types of previous occupation?_____________________________________________________
Have you ever suffered from an occupational disease or injury?___________________________
Have you ever been discharge or rejected on medicals grounds?___________________________
Date of last vaccination___________________________________________________________

Have you ever suffered from any of the following: (Answer “Yes” or “No”, if yes give details)
Rheumatic fever: Yes/No Any other illnesses: Yes/No
Heart Trouble: Yes/No Jaundices: Yes/No
Stomach or other digestive disorder: Yes/No Diabetes: Yes/No
Asthma: Yes/No, Pleurisy: Yes/No Fits fainting or dizziness: Yes/No
Plum TB: Yes/No, Chest Bronchitis: Yes/No Nervous mental disease of any kinds: Yes/No
Kidney Disease: Yes/No Veneral Disease: Yes/No
Malaria: Yes/No Dermatitis or any skin disease: Yes/No
Thyroid fever: Yes/No Any allergy or: Yes/No
Sinusitis: Yes/No Ear allergy or: Yes/No
Operation or Injuries: Yes/No Menstrual history: L.M.P.
Do you have any physical handicap: Yes/No 4. I declare that the above statement are true and complete to the best of my knowledge and behalf and I agree that the results of this medical examination in general terms may be revealed to the company if required I also fully understand that if any of the said statement if proved wrong the company may have unwitting engaged my services and I shall therefore have no claim against the company, if for these reason I m discharged from its services.

Date: _______________ Signature of prospective Employee 5. RESULT OF PHYSICAL EXAMINATION (by qualified medical practitioner, no investigation test to be performed) 1. General Appearance:___________________________________ Skin:_______________________________ 2. Throat_________________________ Tonsils_____________________ Glands________________________ 3. Ears_______________________ Hearing E.G. Wishper.20 ft_______________________ Nose___________ 4. Teeth & Gums__________________________________ Tongue ___________________________________ 5. Vision Distant: R.E.__________ L.E._____________ Corrected R.E._____________ L.E._______________ Near: R.E.__________________ L.E._____________ Corrected R.E._____________ L.E._______________ Eye Disease ____________________________________ Color Vision ______________________________ 6. Height ____________________ Chest Exp. ___________________ Insp.____________________________ Weight _________________ Girth of abdomen _________________________________________________ Heart Sound _______________________________________ Murmurs______________________________ Arteries___________________________________________ Blood Pressure__________________________ Pulse Rate_________________________________________ Character______________________________ 7. Lungs___________________________________________________________________________________ 8. Abdomen________________________ Liver_________________________ Spleen____________________ 9. Urinary & Genital Organ___________________________________________________________________ Veneral Diasese___________________________________________________________________________ 10. Special Conditions: Flat Feet_________________________________ Vericose Vein___________________ Hernia__________________________________ Deformities______________________________________ Scars __________________________________________________________________________________ Identification Marks_______________________________________________________________________ 11. Nervous system_________________________________ Pupillary Reaction___________________________ Plantars_____________________ Knee Jerks_______________________ Rhomberg___________________

6. INVESTIGATIONS REQUIRED ( From SRL-Religare Lab only those mentioned below) 1. BloodSugar(f)_________________________________________________________________________ 2. SCreatinine___________________________________________________________________________ 3. HIV,HbSAg____________________________________________________________________________ 4. CBC,Lipidprofile________________________________________________________________________ 5. Other Investigations_____________________________________________________________________ 6. Blood Group___________________________________________________________________________

7. COMMENTS AND RECOMMENDATIONS:

Signature, Registration No. with seal of qualified allopathic medical practitioner.

Similar Documents

Premium Essay

Sdhkjsd

...2016-2017 CONTENTS S.No. Particulars Page No. 1. General Information 1 – 34 2. Faculty of Agricultural Sciences 35 3. Faculty of Arts 38 4. Faculty of Commerce 47 5. Faculty of Engineering & Technology 50 6. Faculty of Law 60 7. Faculty of Life Sciences 61 8. Faculty of Management Studies & Research 66 9. Faculty of Medicine 68 10. Faculty of Science 71 11. Faculty of Social Sciences 77 12. Faculty of Theology 88 13. Faculty of Unani Medicine 90 14. Centre of Professional Courses 92 15. Interdisciplinary Biotechnology Unit 94 16. Faculty of International Studies 95 17. Senior Secondary Schools 97 18. K.A. Nizami Centre for Quranic Studies 100 19. Community College 101 20. Part Time Courses 104 21. Bridge Course, Centre for Promotion of Educational and Cultural Advancement of Muslims of India 118 S.No. Particulars 22. Appendix – I 23. Page No. Appendix – II(A) 24. 25. 26. (Summary of Courses of study (with their Application Form Details & Test Fee) (Undertaking for Non-upgradation of the course / branch/main subject/ stream/ specialization already allotted) 120 128 Appendix – II(B) (Undertaking for submission of required original documents at the time of completion of admission formalities) 129 Appendix – II(C) (Undertaking on behalf...

Words: 59494 - Pages: 238

Free Essay

Spa & Wellness Industry

...http://www.nckvietnam.com Understanding the Global Spa Industry http://www.nckvietnam.com This page intentionally left blank http://www.nckvietnam.com Understanding the Global Spa Industry: Spa Management Marc Cohen and Gerard Bodeker AMSTERDAM • BOSTON • HEIDELBERG • LONDON • NEWYORK • OXFORD • PARIS • SAN DIEGO • SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO Butterworth-Heinemann is an imprint of Elsevier http://www.nckvietnam.com Butterworth-Heinemann is an imprint of Elsevier Linacre House, Jordan Hill, Oxford OX2 8DP, UK 30 Corporate Drive, Suite 400, Burlington, MA01803, USA First edition 2008 Copyright © 2008 Elsevier Ltd. All rights reserved No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher Permissions may be sought directly from Elsevier’s Science & Technology Rights Department in Oxford, UK: phone ( 44) (0) 1865 843830; fax ( 44) (0) 1865 853333; email: permissions@elsevier.com. Alternatively you can submit your request online by visiting the Elsevier web site at http:/ /elsevier.com/locate/permissions, and selecting Obtaining permission to use Elsevier material Notice No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any...

Words: 153860 - Pages: 616