Format of Medical Certificate

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Annexure 7 MEDICAL CERTIFICATE (to be issued by a Registered Medical Practitioner) ‘GENERAT, EXPECTATIONS © Vision shuld be nom. ete of defective vision, it shouldbe corte to 619 in bath eyes or 66 inthe ter eye. Cla blind abd uni cla (ving iston in only oe ye) petsons ae rece Hom admission cera cous, 1 Hering shouldbe aml, Defective esrng should be casted ‘ear a ngs should nt have ay abnormality and there sould be no histary of metal lnes an epilepsies. 1] Nanieof the candidate Gander 2 | Mnifcation Mark (a mole, scar or bitimae®), any 3] Major inesToperatin,iFany epesiy nature oF Mines operation) 7 | Rega om Waitin Blood Group 3 Fas Finony ay Menal ine (©) Epileptic Fs ©] Chas Inspiration tae DEepraton now 7 [rearing 7] Vision with or witout —] Right Eye Tait ye] Colour Biness Uniocular vision (having lasses Vision in only one eye) | Respiratory Sytem To] Nervous Sytem [Teer 1a) Sounds WO Marmar Tr | Abdomen Te Tiyarossle (@)Liver (b) Spleen ‘Ray other defects: Certificate of Medica Fitness ‘The candidate fulfils the prescribed standand physical fimess, medical ness and is FIT for admission Engincering’Architecture! Pharmaceutics! Seience Course The candidate does not fulfil the prescribed standard of physical fitnessmedical fitness and is unfittemporarily unfit for admission due to following detest ‘Name ofthe Dostor Regn. No Signature with dato Seal 87

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