Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 40 views

    Certificate of Medical Fitness

    Uploaded by

    arivu ravi
    1. The document is a medical certificate form required for a driving license application. 2. It requires information about the applicant's vision, color blindness, hearing, physical defects, and blood type if desired. 3. The examining medical practitioner must certify whether the applicant is physically fit to hold a driving license based on examination of vision, hearing, limbs, joints, and reaction time.

    Copyright:

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

    Certificate of Medical Fitness

    Uploaded by

    arivu ravi
    40 views2 pages
    1. The document is a medical certificate form required for a driving license application. 2. It requires information about the applicant's vision, color blindness, hearing, physical defects, and blood type if desired. 3. The examining medical practitioner must certify whether the applicant is physically fit to hold a driving license based on examination of vision, hearing, limbs, joints, and reaction time.

    Original Description:

    DL renewal, medical fitness certificate

    Original Title

    Form 1A

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    1. The document is a medical certificate form required for a driving license application. 2. It requires information about the applicant's vision, color blindness, hearing, physical defects, and blood type if desired. 3. The examining medical practitioner must certify whether the applicant is physically fit to hold a driving license based on examination of vision, hearing, limbs, joints, and reaction time.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    40 views2 pages

    Certificate of Medical Fitness

    Uploaded by

    arivu ravi
    1. The document is a medical certificate form required for a driving license application. 2. It requires information about the applicant's vision, color blindness, hearing, physical defects, and blood type if desired. 3. The examining medical practitioner must certify whether the applicant is physically fit to hold a driving license based on examination of vision, hearing, limbs, joints, and reaction time.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    FORM 1-A

    MEDICAL CERTIFICATE
    [See rules 5(1), (3), 7, 10(a), 14(d) and 18(d)]
    (To be filled in by a registered medical practitioner appointed by the State Government or person authorized in this behalf by the
    State Government referred to under sub section (3) of section 8)

    1. Name of the applicant ……………………………………………………………………………


    2. Identification Marks 1.
    2.
    a) Does the applicant to the best of your judgement suffer from any
    Yes / No
        defect of vision? If so, has it been corrected by suitable spectacles?
    b) Can the applicant to the best of your judgement readily distinguish
    Yes / No
        the pigmentary colors, Red and Green?
    c) In your opinion is he able to distinguish with his eyesight of a distance
    Yes / No
        of 25 meters in good day light a motor car Number plates?
    d) In your opinion does the applicant suffer from a degree of deafness
    Yes / No
        that would prevent his hearing the ordinary sound signals?
    e) In your opinion does the applicant suffer from night blindness? Yes / No
    f) Has the applicant any defect or deformity or loss of member which
        interfere with the efficient performance of his duties as a driver? If so Yes / No
        give your reasons in detail.
    g) .........................................................................................
    Optional
    a) Blood Group of the applicant (if the applicant so desires that the
        information may be noted his driving license)
    b) RH factor of the applicant (if the applicant so desires that the information
        may be noted his driving license)
    Declaration made by the applicant in Form 1 as to physical fitness is attached.
    Certificate of Medical Fitness
    I certify that: -
    (i) I have personally examined the applicant ……………………………………………………………
    (ii) That while examining the applicant I have directed special attention to his/her distant vision and
    hearing ability, the condition of arms, legs, hand and joints of both extremities of the applicant.
    (iii) I have personally examined the applicant for reaction time side vision and glare recovery,
    (applicable in case persons applying for a license to drive goods carriage carrying goods of
    dangerous or hazardous nature to human life)
    (iv) Applicant’s colour vision has been tested using standard ishihara chart and the applicant has not
    been found suffering from severe or total colour blindness
    And, therefore I certify that to the best of my judgment, he/she is medically fit/not fit to hold a driving
    license.
    The applicant is not medically fit to hold a license for the following reasons: -

    Signature
    1. Name and designation of the medical Officer/Practitioner

    (Seal)

    2. Regn. No. of the medical Officer

    Date: Signature/Thumb impression of the applicant

    Note: The Medical Officer shall affix his signature partly on the photo and partly on the certificate

    You might also like