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 : 08276-278963 Sainik School Kodagu

Fax : 08276-278965 (Under Ministry of Defence)
Email : [email protected] PO: Kudige, Kushalnagar Taluk
Website :www.sainikschoolkodagu.edu.in Dist. Kodagu – 571232

No. SSKG/MO/0622/Med/2021-22 07 Mar 2022

Sri/Smt ________________________________
_______________________________________
(List of AISSEE-2022 Medical Examination Date Sheet enclosed at Appendix-A)

MEDICAL EXAMINATION FOR ADMISSION TO

SAINIK SCHOOL KODAGU FOR ACADEMIC SESSION 2022-23

Dear sir / madam,

1. It is informed that your ward AISSEE Roll No._______________ Master / Kumari

______________________________, having qualified in the written examination for Class-VI
conducted on 09 January 2022 (Sunday), stands shortlisted to appear for the Medical
Examination. Schedule of Medical Examination to be carried out at District Hospital, Madikeri,
District Kodagu, PIN: 571 201, Karnataka in Batches is enclosed as per details attached at
Appendix-A. All parents are directed to report along with their ward at District Hospital,
Madikeri as per details mentioned in the Appendix. Hence, it is advised to note the AISSEE-
2022 Roll Number, Batch and date of reporting carefully to plan your travel / stay programme
accordingly. Requests for change of dates for Medical Examination will not be accepted.

2. It is essential for the candidates to attend the medical examination accompanied by the
parent only, i.e. father or mother (if the father is deceased); guardian (in case both the parents
are deceased). The parent / guardian is to bring the Medical History Form & Child’s Health
Record Sheet (Enclosures – 1 & 2) duly completed in all respects in consultation with a
Qualified Medical Practitioner and signed by the candidate.

3. Your ward is also required to produce this original letter to the School
Representative at the time of reporting to Medical Examination for verification failing
which, the candidate will not be allowed to appear for the Medical Examination.

4. No TA & DA will be admissible for appearing in the Medical Examination. Madikeri is

District Headquarters for Kodagu District. KSRTC Buses connectivity from all major cities of
Karnataka state is available. Nearest Railway Stations are Mysore-120 Km and Mangalore-140
Km approximately. Auto Rickshaws are available at Madikeri Bus Station for commuting to and
fro District Hospital. You are advised to make your own arrangements (for boarding / lodging) at
Madikeri for attending medical examination as per schedule.

5. To facilitate candidates attending Medical Examination, parents are requested to note

following points:-
(a) Arrive and stay in Madikeri on previous day of Medical Examination schedule
under own arrangements.
(b) On the day of Medical Examination, bring your ward after breakfast to the District
Hospital at 0800 hrs.
(c) Provide drinking water bottle and sufficient snacks to your ward on the day of
Medical Examination as he needs to stay in the District Hospital upto 1500 hrs.
(d) Parents / guardians are not allowed to accompany the candidate inside the
Hospital for Medical Examinations in District Hospital; it is strictly prohibited failing which
the candidature of your ward would be cancelled for admission.
 2

(e) All COVID precautions / guidelines are to be followed by the candidate and
escort during journey / stay and at District Hospital. Always wear masks, maintain social
distancing and bring your own hand sanitizer.
(f) On completion of the Medical Examination, the candidates would be allowed to
disperse (accompanied by the parents) from the District Hospital, Madikeri in
consultation with the School Representative.

6. For attending the Medical Examination, you are requested to bring the following without
fail:-
(a) Copy of Admit Card
(b) Copy of Marks List
(c) Demand Draft for Rs.100/- in favour of Principal Sainik School Kodagu payable
at Kushalnagar, Karnataka towards Medical Examination Fee.
(d) Duly completed Medical History Form & Child’s Health Record Form
(enclosed with this letter).
(e) Four recent Passport size Photographs of the candidate.
(f) Ear Wax Clearance Certificate from ENT Specialist doctor.
(g) X-Ray Chest PA view and USG Abdomen & pelvis Ultrasound Scanning Reports
(from Rege. Radiologists only) as mentioned at Para 14 & 15 of Encl-1 to be attached.

7. The under mentioned medical tests are to be carried out by District Hospital, Madikeri
to the candidates one day / two days before reporting of candidate for Medical Examination
date. Parents are advised to plan their journey and stay at Madikeri accordingly.

(a) Complete Haemogram of Blood of the candidate.

(b) Urine RE / ME of the candidate.

8. Important Note (for Candidates). Candidates are being called for the Medical
Examination in the ratio of 1:3 in each category as per the regulations of Sainik Schools
Society. Hence, the Call for Medical Examination does not constitute offer of a seat
in Sainik School Kodagu. Admission to Sainik Schools is based on the rank (inter-se-
merit) in the School wise, Class wise, Gender wise, Category wise merit list, subject to
qualifying written test (AISSEE-2022), medical fitness (as certified by designated Medical
Authorities), verification of original documents / certificates, vacancies, extant policy on
reservations and confirmation of other eligibility conditions. Candidates, as per merit and
meeting all eligibility conditions, will be intimated separately through letter of admission.

9. You are to make all arrangements for transport, stay, food, lodging during the Medical
Exam and this School does not provide any of these facilities.

Yours faithfully,

(G Kannan)
Colonel
Principal
Enclosures:
(1) Medical Examination Date Sheet (Appendix-A)
(2) Medical History Sheet (Enclosure-1)
(3) Child’s Health Record (Enclosure-2)
NOTE: Parents i.e. father or mother or guardian should accompany the candidate along
with your Identity Card i.e. Aadhar Card (OR) Voter ID Card (OR) Driving License (OR)
Employee ID failing which, candidature of your ward will not be entertained for Medical
Examination.
 Appendix-A
SAINIK SCHOOL KODAGU
MEDICAL EXAMINATION DATES FOR THE SHORTLISTED CANDIDATES OF AISSEE-2022
[At District Hospital Madikeri, Kodagu District, Karnataka, PIN-571201]

CLASS-VI (BOYS) – BATCH-I – 14 March 2022 At 0800 Hrs (MONDAY) (TOTAL-40)

2701010088 2701020259 2701030109 2702020150 2703010134 2703010255 2703010308
2704020059 2704020343 2704020857 2705010042 2706010220 2706010259 2706010385
2706010475 2708010283 2708010416 2708010450 2708010727 2712010125 2712010142
2701010082 2701030003 2701030183 2703010055 2704020221 2704030186 2708010440
2708010483 2711010061 2701020038 2701020346 2701020435 2701030020 2701030170
2701030301 2701030326 2701030412 2702010112 2702010224 - -
CLASS-VI (BOYS) – BATCH-I – 15 March 2022 At 0800 Hrs (TUESDAY) (TOTAL-40)
2702010297 2702010359 2702020345 2702020369 2704010303 2704020173 2704020229
2704030549 2705010002 2705010150 2705010157 2705010167 2705010228 2705010234
2706010124 2706010126 2706010187 2706010461 2706010467 2706010474 2706010547
2707010202 2707010250 2707020283 2707020332 2708010170 2708010605 2708030372
2710010019 2711020022 2712010015 3802010178 2701020201 2701020270 2701020376
2701020431 2701030209 2702020187 2702030027 2702030061 - -
CLASS-VI (BOYS) – BATCH-I – 16 March 2022 At 0800 Hrs (WEDNESDAY) (TOTAL-40)
2702030105 2702030358 2703010082 2704040759 2707010462 2707010664 2707020441
3001040403 3114030328 3301010022 2701010078 2701010116 2701010134 2701010155
2701010158 2701020240 2701020280 2701020335 2701020341 2701030081 2701030089
2701030095 2701030108 2701030227 2701030272 2701030332 2701030372 2701040033
2701040079 2701040129 2701040173 2701040189 2701040199 2702010001 2702010114
2702020401 2703010079 2703010120 2703020084 2703020262 - -
CLASS-VI (BOYS) – BATCH-I – 17 March 2022 At 0800 Hrs (THURSDAY) (TOTAL-40)
2704020118 2704020285 2704030039 2704030076 2704030440 2704030906 2704040804
2705010134 2705010135 2705010180 2705010193 2705010246 2705010253 2706010179
2706010523 2706010530 2707010054 2707020384 2707020396 2708010176 2708010405
2708010509 2708010743 2708020029 2708020323 2711020060 2712010291 1201010119
1502010057 2708020100 3116020016 3904040733 3905030196 4103010318 4401010123
4408020037 1210040122 4201030594 4201050235 1210020220 - -
CLASS-VI (BOYS) – BATCH-I – 18 March 2022 At 0800 Hrs (FRIDAY) (TOTAL-40)
1210020489 1210040207 1509010116 1511040442 1513010048 1513010239 3111020120
3115010180 3115040269 3901010252 3904040751 3905030273 4201040181 4401020016
4405010073 4405010209 4405020192 1511020077 1511060388 2701010102 3905010218
3905010270 4401030350 1203020005 1203020150 1203020383 1210040250 1505010978
1506020341 1511020007 1512020159 1512020171 1513010017 1513020061 1513020143
2701020273 2701030125 3002020396 3111020171 3901010192 - -
CLASS-VI (BOYS-10 & GIRLS-29 ) – BATCH-I – 21 March 2022 At 0800 Hrs (MONDAY) (TOTAL-39)
3903010144 3904020258 3904040155 4201020132 4201040219 4201050258 4401010118
4401020427 4401020648 4411010378 2702010380 2705010217 2708030242 2708010242
2708020488 2704030826 2703020284 2705010190 2707020382 2701030205 2707010572
3111020144 2701020077 2701020467 2701030088 1201010461 1507010001 2712010123
1201010328 4202020306 1511030433 1513010162 2701030005 2710010046 2701020029
2701020151 2701040201 2707020398 3905050159 - - -
 Enclosure-1
MEDICAL HISTORY SHEET – 2021-22 SESSION
(To be filled in Capital letters only)

This certificate must be filled up and signed by the parent/guardian and Medical
Practitioner (as per Para 2 of Call Letter) before the boy / girl appears for Medical
Examination.

1. Name of the Candidate: __________________________________________

2. Sex : Male / Female __________________________________________

3. Exam Roll No. __________________________________________

4. Date of Birth ___________________________________________

5. Father’s Name ___________________________________________

6. Mother’s Name ___________________________________________

7. Contact No. (Mobile) ___________________________________________

8. E-mail ID ___________________________________________

9. Identification Marks : (a) ___________________________________________

(b) ___________________________________________

10. Permanent Address : ____________________________________________

____________________________________________

____________________________________________

____________________________________________

PERSONAL STATEMENT

11. FAMILY HISTORY

Relation If Alive If Expired
Age (yrs) Health Cause of Death Died (yrs)
Father
Mother
Brother / Sister

Any Family Hypertension Heart Diabetes Bleeding Mental

History of -> Disease Disorders Disease

Contd…2/-
 2

12. PERSONAL HISTORY

Have you suffered from any of the following illness / conditions?
Illness Yes / No Illness Yes / No
Chronic Bronchitis / Asthma Trachoma
Pleurisy / Tuberculosis Night Blindness
Rheumatism / Frequent SoreThroat Laser Treatment / Surgery for Eye
Chronic Indigestion Any Other Eye Disease
Kidney / Bladder Problem Discharge from Ears
Incontinence of Urine Any Other Ear disease
STD (Sexually Transmitted Disease) Frequent Cough & Cold / Sinusitis
Jaundice Nervous Breakdown / Mental illness
Air/Sea/Car/ Train sickness Fits/ Fainting Attacks
Chicken Pox Severe Head Injury
Whooping Cough (For Female Candidates Only)
Diphtheria Breast Disease / Discharge
Typhoid Menstrual Disorders
Rubella (German measles)
Has he/she been actively immunized against the following diseases
Disease Yes / No Disease Yes / No
DPT Hepatitis A & B
Chickenpox Any other disease
Inoculated against Typhoid
Has he/she ever suffer from Leprosy (Hanson’s disease)? If so, give history of the case.

Does he/she suffer from any ailment or constitutional peculiarity affecting general health, sight, hearing etc

Are the Teeth in good condition?

Does the boy/girl wear glasses? If so prescription may be attached with this certificate

Has the boy/girl been declared allergic to any medicine by any doctor? If so, give the name of the medicine in
block letters.

Is he/she fit in all respects for ordinary school life in your opinion?

Have you ever been rejected as medically unfit for any Sainik School / RMS / RIMC under the aegis of
Ministry of Defence.

Have you ever been discharged as medically unfit from any Sainik School / RMS / RIMC under the aegis of
Ministry of Defence.

Have you ever been admitted in hospital for any illness, operation or injury? If so, state the nature of the disease
and duration of stay in hospital.

Any other information you can give about your health ?

Contd…3/-
 3

13. BLOOD REPORT & URINE EXAMINATION REPORT

(Note: Reports are to be attached to this document)
Blood Investigation Urine Examination Report

Hemoglobin % Appearance Albumin Sugar Sp. Gravity

TLC

DLC

RBS

14. X-Ray Chest PA view (for Boys & Girls) [Note: X-Ray Report from Registered Radiologist
only are to be attached with this document ]

15. USG Abdomen & Pelvis (for Girl candidate only) [Ultrasound Scanning Reports from
Registered Radiologist only are to be attached with this document]

I hereby declare that I have answered as fully as possible all the questions about my
family and personal health and that the information given is true to the best of my
knowledge.

Signature of Candidate Signature of Medical Officer

Date : Name :
Reg No :
Seal of Health Facility:
 Enclosure-2
CHILD’S HEALTH RECORD
(To be filled in Capital letters only)

Entrance Exam Roll No _______________________________________ Recent

Name of Candidate _______________________________________ Photograph of
the candidate
Blood Group _______________________________________
Father’s Name _______________________________________
Mother’s Name _______________________________________
Contact No. (Mobile) _______________________________________
E-mail ID _______________________________________

VACCINATION HISTORY
Immunization Age Date
Zero dose of Polio At birth (within 14 days)
Zero dose of Hepatitis-B At birth (within 24 hrs of birth)
BCG At birth (within 1 month)
Oral polio 1st dose month (6thweek)
Inj DPT 1st dose month (6thweek)
HIB 1st dose month (6thweek)
Inj Hepatitis B1 month (6thweek)
Oral Polio 2nd dose month (10thweek)
Inj DPT 2nd dose month (10thweek)
HIB 2nd dose month (10thweek)
Inj Hepatitis B2 month (10thweek)
Oral Polio 3rd dose month (14thweek)
Inj DPT 3rd dose month (14thweek)
HIB 3rd dose month (14thweek)
Inj Hepatitis B3 month (14thweek)
Measles Vit ‘A’ After completion of 9 month
Inj DPT (Booster dose) Years (18 months)
Inj DPT (DT) After 5 years (1st std)
Inj TT 4th std (10 Years)
Allergy to any food, What Happened & How Severe Medication Taken at the time of
Adhesive Tape, Bee Sting Allergy?

Does the Child have any problem during physical activity?

Signature of Father: __________________________ Signature of Mother: ______________________