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    Medical CertificateProforma

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    Arindam
    This document is a proforma for a medical certificate of fitness from a MBBS qualified doctor. It requests information such as the patient's name, father's name, doctor's name, blood group, date of vaccinations, history of injuries and allergies, current medications, and a certificate stating the student is free from communicable diseases and certain conditions like heart disease, hypertension, asthma, seizures, diabetes, or psychiatric diseases. It notes that any such conditions must be declared to the medical officer of the institute upon joining.

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    Medical CertificateProforma

    Uploaded by

    Arindam
    77 views1 page
    This document is a proforma for a medical certificate of fitness from a MBBS qualified doctor. It requests information such as the patient's name, father's name, doctor's name, blood group, date of vaccinations, history of injuries and allergies, current medications, and a certificate stating the student is free from communicable diseases and certain conditions like heart disease, hypertension, asthma, seizures, diabetes, or psychiatric diseases. It notes that any such conditions must be declared to the medical officer of the institute upon joining.

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    Performa for medical certificate

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    Medical-CertificateProforma

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    This document is a proforma for a medical certificate of fitness from a MBBS qualified doctor. It requests information such as the patient's name, father's name, doctor's name, blood group, date of vaccinations, history of injuries and allergies, current medications, and a certificate stating the student is free from communicable diseases and certain conditions like heart disease, hypertension, asthma, seizures, diabetes, or psychiatric diseases. It notes that any such conditions must be declared to the medical officer of the institute upon joining.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    77 views1 page

    Medical CertificateProforma

    Uploaded by

    Arindam
    This document is a proforma for a medical certificate of fitness from a MBBS qualified doctor. It requests information such as the patient's name, father's name, doctor's name, blood group, date of vaccinations, history of injuries and allergies, current medications, and a certificate stating the student is free from communicable diseases and certain conditions like heart disease, hypertension, asthma, seizures, diabetes, or psychiatric diseases. It notes that any such conditions must be declared to the medical officer of the institute upon joining.

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    PROFORMA FOR MEDICALCERTIFICATE OF FITNESS

    FROM MBBS QUALIFIED DOCTOR (ON HIS/HER


    LETTER HEAD OR LETTER HEAD OF THE HOSPITAL)

    Name : ………………………………………………………………….
    Father’s Name : …………………………………………………………………..
    Name of Doctor : …………………………………………………………..
    Medical History
    a) Blood Group
    b) Date of Vaccination: (i) Chicken Pox …………………………………………………
    (ii) Hepatitis B …….………... …………………………………
    (iii) Tetanus……………………………………………………..
    (iv) Typhoid……………………………………………………..
    c) Injuries in the Recent Past :
    d) Allergies to drugs, medicines or any other thing like food item etc.
    e) History of current medication (attach sheet if required)
    f) Certificate by doctor to state that the student is free from any communicable disease and
    is not suffering from or ever suffered from diseases which need immediate medical
    attention like Congenial Heart disease, Rheumatic Heart Disease, Hypertension,
    Bronchial Asthma, Seizures, Diabetes Mellitus or Psychiatry related
    diseases etc.

    Note: If so then the same must be mentioned / declared with the medical officer of the Institute
    immediately at the time of joining to enable quicker and suitable response in case of
    emergency

    Sign. of Student Sign. of Parent Sign. of Medical Officer

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