Gcc
Gcc
C Code No:
Address: GCC Slip No:
Phone: Fax: Date Examined:
Email: Report Expiry Date:
CANDIDATE INFORMATION
Name Age Nationality
Photo
Gender Marital Status Profession
Passport No Place of issue Travelling To
Medical Examination: General Investigation
Height Weight Kgs BMI Chest X-Ray
cm
B.P / Pulse /min RR Laboratory Investigation
/min
Unaided Aided TYPE OF LAB INVESTIGATION RESULTS
Visual Acuity
Rt. Eye Lt. Eye Rt. Eye Lt.Eye BLOOD GROUP
Distant /6 /6 /6 /6 HAEMOGLOBIN
Near 20/20 20/20 20/20 20/20 THICK FILM FOR
Cooler Vision Normal Doubtful Defective 1. MALARIA
Hearing Rt. Ear Lt. Ear 2. MICRO FILARIA
BIOCHEMISTRY
Medical Examination: Systemic Findings R.B.S
GENERAL APPEARANCE L.F.T.
CARDIOVASCULAR CREATININE
RESPIRATORY SEROLOGY
ENT HIV I & II
GASTRO INTESTINAL: HBs Ag
ABDOMEN (Mass, tenderness) Anti HCV
HERNIA VDRL Positive
GENITOURINARY TPHA Positive
HYDROCELE Treatment Name
MUSCULOSKELETAL Dosage
EXTREMITIES Date
BACK URINE
SKIN SUGAR
C.N.S ALBUMIN
DEFORMITIES STOOL
MENTAL STATUS EXAMINATION ROUTINE
A. Appearance HELMINTHES
Speech OVA
Behavior CYST
B. Cognition: OTHERS
Orientation VACCINATION STATUS
Memory TYPE STATUS DATE
Concentration Polio YES/NO
C. Mood MMR 1 YES/NO
D. Thoughts MMR 2 YES/NO
OTHERS: Meningococcal YES/NO
Remarks
Dear Sir/Madam,
Mentioned above is the medical report for Mr./Miss ______________________ who is FIT/UNFIT for the
above mentioned job according to the GCC Criteria.
BAR CODE