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Medical Report: (I) (Ii) (Iii) (Iv) (V) (Vi) (Vii)

This medical report requests information about an applicant's name, age, sex, height, weight, and blood group. It asks the certifying doctor questions about the applicant's current health, physical and mental fitness for prolonged travel and stay in India, and freedom from infectious diseases. The doctor is also asked to list any abnormalities found on a chest x-ray and certify that the applicant is medically fit to travel to India and that no unusual health risks are foreseeable.

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Ayoub Fajraoui
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61 views1 page

Medical Report: (I) (Ii) (Iii) (Iv) (V) (Vi) (Vii)

This medical report requests information about an applicant's name, age, sex, height, weight, and blood group. It asks the certifying doctor questions about the applicant's current health, physical and mental fitness for prolonged travel and stay in India, and freedom from infectious diseases. The doctor is also asked to list any abnormalities found on a chest x-ray and certify that the applicant is medically fit to travel to India and that no unusual health risks are foreseeable.

Uploaded by

Ayoub Fajraoui
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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MEDICAL REPORT

[To be certified by a doctor/hospital on the panel of the Indian Mission/UN Mission (if any) or
as designated by Indian Mission]

(i) Name of Applicant:


(ii) Age:
(iii) Sex: (Male / Female)
(iv) Height (cm):

(v) Weight (kg):

(vi) Blood Group:

(vii) Blood Pressure:

1. Is the person examined in good health at present?

2. Is the person examined physically and mentally for a


prolonged stay in India to carry out research work away
from home?
3. Is the person free of infectious diseases (HIV/AIDS,
tuberculosis, trachoma, skin diseases etc), Yellow Fever
certificate (in case of people coming from that region or
as laid out in WHO regulations)?
4. Does the person examined have any medical condition
or defect which might require treatment during the
course?
5. List of any observed abnormalities indicated in the
chest X ray.

I certify that the applicant is medically fit in all respects or a prolonged stay in India and that no unusual
health risks can be fore seen.

Name of Doctor/Physician:
Registration No:
Address of Clinic/Hospital:
Telephone Email:
Date:
Signature of Doctor/Physician Seal of Clinic/Hospital:

* Please read the form carefully. Inaccurate information may lead to rejection of application.
* Female candidates are hereby advised that they should not travel to attend the course applied for in case they are undergoing pregnancy.

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