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Medical Certificate Sample

This document is a certificate of medical fitness that must be obtained from a government medical officer and submitted at the time of joining. It requires information including the name, father's name, blood group, height, weight, chest measurements, and examination of heart, lungs, vision, color vision, hearing, hernia, and any other diagnosed diseases or allergies. The certifying medical officer confirms that they have examined the candidate, who is free of any mental or physical diseases and is medically fit.

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tacharya1
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1K views

Medical Certificate Sample

This document is a certificate of medical fitness that must be obtained from a government medical officer and submitted at the time of joining. It requires information including the name, father's name, blood group, height, weight, chest measurements, and examination of heart, lungs, vision, color vision, hearing, hernia, and any other diagnosed diseases or allergies. The certifying medical officer confirms that they have examined the candidate, who is free of any mental or physical diseases and is medically fit.

Uploaded by

tacharya1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CERTIFICATE OF MEDICAL FITNESS

(TO BE DEPOSITED A T THE TIME OF JOINING)


To be obtained only from Gazetted Government Medical officer/Medical Officer of a Government
Undertaking. (Please note that in no other form this certificate will be accepted. Medical Certificates
issued by private medical practitioners will not be accepted.)
Name.........................................................................................................................................................
(in Block Letters)
Fathers Name : ........................................................................................................................................
Blood group/Anemic (Blood Count) ..
Height : ......................................................................... Weight ................................................................
Chest:..........................................................................................................................................................
Heart and Lungs : ......................................................................................................................................
Vision : L : ...................................................... R : .....................................................................................
Colour Vision : ...........................................................................................................................................
Hearing : ....................................................................................................................................................
Hernia/Hydrocele/Piles : ............................................................................................................................
Any other disease diagnosed in past: ..
Allergies, if any..
List of prescribed medication, If any
1.
2.
3. .
Any other Remarks : ..
I certify that I have carefully examined Mr./Ms.............................................................son/daughter of Mr.
.............................................................................who has signed in my presence. He/she has no mental
and physical disease and is FIT.

Signature of the candidate

Station : ....................................
Date : ....................................

Signature of the Medical Officer


with legible seal.

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