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5 Pre-EmploymentMedical Examination

The document appears to be a pre-employment medical examination form that collects an individual's personal information such as name, date of birth, gender, nationality, height, weight, and medical history. The form includes sections to record results from a physical examination, laboratory tests, and fitness determination. Upon completion, the examining medical officer would provide any remarks and sign off on the findings.

Uploaded by

Ahmed Habib
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
518 views9 pages

5 Pre-EmploymentMedical Examination

The document appears to be a pre-employment medical examination form that collects an individual's personal information such as name, date of birth, gender, nationality, height, weight, and medical history. The form includes sections to record results from a physical examination, laboratory tests, and fitness determination. Upon completion, the examining medical officer would provide any remarks and sign off on the findings.

Uploaded by

Ahmed Habib
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Meem Group

Pre-Employment Medical Examination

Name :…………………………………………………………………………………………………………...……………………………………..………………………….

Designation
:…………………………………………………………………………………………………………………………..………………………………………………….
Date of Birth (DoB)
.…….……………..………………DD ……...…..…..…….…..MM …..……….…………….. YYYY Age: ………………….…..Years
Gender
Nationality Male
Material Status :………………………………………………...…………………………………………………………………………………………………………….

Height Unmarried
:…………………………………………………………………………………………………………...………………………………………………….…………….
Weight
:………………………………………………………………………………………………..………………………...………………………………………………….
National ID Card/Passport
Ha- :…………………………………………………………………………………………………………...…………………..…………………………………………… .
Medical / Physical Examination Laboratory Examination
Eye……………………………………………………………….………….……………….. 1. Urine R/E 5

Ear……………………………………………………………….…………………………….. M/E 5

Blood Pressure…………………….……………………….……………………… 2. Stool R/E 5

Heart…………………………………………………………………………………………. M/E 5

Lungs………………………………………………………………………………………… 3. Blood Blood Group 5

Chest X-ray…………………………………………………………………………….. Haemoglobin 5

Abdomen……………………………………………………………………………….. 4. Serology RBS 5

Skin…………………………………………………………………………………………... LFT 5

Any Deformaties……………………………………………………………...…. Creatinine 5

CNS…………………………………………………………………………………………... 5. Elisa HIV I & II 5

Psychiatry……………………………………………………………………..………… Hbs Ag 5
Identification Mark………………………………………………………...…. Anti HCV 5
Others…….………………………………………………………………………………. 6. VDRL Test

Please Mark: Medically Fit 5 Unfit 5

Remarks: …………………………………………………………………….……………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

Name & Signature


Medical Officer

D:\Work\Recruitment & Selection\Joining Kit\New folder\2 Pre-EmploymentMedical ExaminationMedical Form 03

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