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  • Is Health Evaluation Form

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    Ngoc Nguyen
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    This document contains a health evaluation form for students applying to study at Qatar University. [1] The form must be completed by an authorized medical clinic or hospital and submitted to the Scholarship and International Admissions Section. [2] It requests information about the student like name, date of birth, nationality, and medical test results. [3] Doctors are asked to indicate if the student is medically fit or unfit to study abroad based on their physical examination and medical history.

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    This document contains a health evaluation form for students applying to study at Qatar University. [1] The form must be completed by an authorized medical clinic or hospital and submitted to the Scholarship and International Admissions Section. [2] It requests information about the student like name, date of birth, nationality, and medical test results. [3] Doctors are asked to indicate if the student is medically fit or unfit to study abroad based on their physical examination and medical history.

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    © All Rights Reserved
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    7 views1 page

    Is Health Evaluation Form

    Uploaded by

    Ngoc Nguyen
    This document contains a health evaluation form for students applying to study at Qatar University. [1] The form must be completed by an authorized medical clinic or hospital and submitted to the Scholarship and International Admissions Section. [2] It requests information about the student like name, date of birth, nationality, and medical test results. [3] Doctors are asked to indicate if the student is medically fit or unfit to study abroad based on their physical examination and medical history.

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    ‫ﻗﺴﻢ اﻟﻤﻨﺢ اﻟﺪراﺳﻴﺔ واﻟﻄﻠﺒﺔ اﻟﺪوﻟﻴﻴﻦ‬

    Scholarships and International Admissions Section

    Health Evaluation
    This form should be completed by an authorized clinic/hospital and then the student should send it to the
    Scholarship and International Admissions Section at Qatar University within the assigned timeline.

    Student’s Information:

    Date: Name:

    Gender: M F Date of Birth: Nationality:

    Purpose of Medical Examination: Fitness Certificate for study at Qatar University

    Normal Abnormal Negative Positive


    CXR Anti-HCV
    Creatinine HCV PCR
    Negative Positive RPR
    HIV PPD .......... mm

    HBsAg Quantiferon TB
    Anti HBs
    For HBV Vaccination Indeterminate Qantiferon TB

    Medical History:
    Any disease/disorder that requires medication and can affect the quality of life and learning/education like Epilepsy, Autism,
    Hearing Problems, Bronchial Asthma, Psychiatric disorders? Please describe and list the taken medication if yes,.............................
    .................................................................................................................................................................................................
    .................................................................................................................................................................................................
    .................................................................................................................................................................................................

    Physical examination:

    BP: P: Height: Weight in KG: Vision R/L:

    DOCTOR’S COMMENTS:
    ...................................................................................................................................................................................................
    ...................................................................................................................................................................................................
    ...................................................................................................................................................................................................

    Fit Unfit to study abroad Doctor’s Signature/Hospital/Clinic stamp:

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