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Medical Examination Report

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Sai Bala
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125 views2 pages

Medical Examination Report

Medical form

Uploaded by

Sai Bala
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
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% Annas Bank {AGout ond Undertking) MEDICAL EXAMINATION REPORT art ~ Candidate's Statement PERSONAL HISTORY: 1) Name 2 hee ears < pate ‘Maret Sage ya ear mer Tm ar vaai ~ fer TUBERCULOSIS SPITTING OF BLOOD 7 ves. No Ty Bid pao ster rom aise (isdnee, Tor CONVULSIONS 7 We ou eve festa fr HENTAL os Doyesioce oreo cul? Ba you gt mis of DEPRESSION? Woe ou ave any SKI ISEASE OF TONG araton™ bo you SON ACHE ae SWELL eyo TW ts you pos URE YOO OFFEN dina doy sedngh sy dodornt you thet you nave DABETES? 7 Wes HOSATALIED any ne? ‘Wer rate foray nas along tine 0 he dos. sw you ntpone ay SURGICAL OPERATION Ho ve dO PORPEMMECINODNESS MENSTRUAL PERIODS REGULAR IRREGULAR DDyeMENOREHOEA: ¥eSINO eNORRHGA vyesno AST MENSTRUAL PENOO: FOR MARRIED CANDIDATES [PREGNANT STAGE OF PREGNANCY ©) WHENO} ouTAE: 4) SMALL POXVACONATION: }__TyPHOD mOCULATION Ne ony manne we Tiare aiass” | Coowe aes ‘Ware HUSBAND /C-HLOREN ‘MOTHER BROTHER'S ‘SISTERS Tsay doar rls ein ade Sooo ormby mo i nd ae Snedinany presence ostical Exaiver Spraten of cana Physical Examination Report Pant Sonora Tee wean Theat Baaonen Noureennt nap ey Goud FauPoce Ee. Ban cor Nowe Throat Noses toning Decree eves RE te Re te. isan vino eng of slassostin sone Slasoe Colour vision Fun Garang BP, ‘osomen Now ‘won monermaily Bones, Joints, Exrenitios _ otormta Paves Tyaroaae TT Urogenital Hernia investigations ‘Oar Tle sn: a6 sug Sereeniag Chest Dociors Remarks Sule racing may be gan éepenang on he vases medical fness as fotows (A) Ft fo servo (8) Tobe kapt on probation fr Sic month to improve elt (C) Not or ‘service tha gadng is 8 of C poate sat easons) cuss: FREMARKE SIGNATURE OF MEDICAL OFFICER Modical Certificate donee covty that have examine, . ® candidate fr employment in Andra Bonk and cannot scover thal hase hes any disease, constitu affection of Bory Ifo O20 nnn —— |. do oot consider this @ dqusiiation for employment n Anche Bank His Hr age Is according ois ‘ner mn statement. oars and appearance about seas ‘Aner Probation

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