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

    Uploaded by

    Kabir Shelke
    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.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

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

    Uploaded by

    Kabir Shelke
    83 views1 page
    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.

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    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.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    83 views1 page

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

    Uploaded by

    Kabir Shelke
    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.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 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

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