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Format of Medical Certificate

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Rounak Das
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268 views1 page

Format of Medical Certificate

Uploaded by

Rounak Das
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Fitness Certificate for admission to Engineering & Technology Courses

(Medical Certificate)

Name ……………………………………………………………… Age ................... Sex ……

I, have examined Mr./ Ms ............................................................................................................carefully and noted as given

below :

1. Personal marks of identification………………………………………………………

2. Height .......................................cms.

3. Weight ...................................... Kgs.

4. General Examination : P…………... / J……….… / Oed…….……. / Cy………

5. Chest Measurement

a) Normal .......................................... cms.

b) Full Inspiration........................... cms.

c) Full Expiration ............................ cms.

6. Eye Sight : Right Eye…………Left Eye…………… Colour Blindness………………

7. Immunization Status :

8. General Physique :

9. Heart :

10. Lungs :

11. Abdominal Viscera :

12. Blood Group :

I, do hereby certify that I, cannot discover that he / she has any disease constitutional affectional of bodily and mental

infirmary…………………

I, Consider that above candidate FIT to join his/ her study.

Signature of the Candidate


Date :

Place: (Signature of Regd. Medical Practitioner)

Name………………………………
Regd. No… .................................. (Seal)

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