OLABISI ONABANJO UNIVERSITY, AGO-IWOYE UNDERGRADUATE PORTAL =| = = DIRECTORATE OF HEALTH SERVICES FRESH STUDENT MEDICAL EXAMINATION HEALTH FORM A [passport Reg. No 75849288HB AGR Medical Number 2119/ST F< 2018 OLADUNJOYE Emmanuel Abiodun Session Admitted 2017/2018 Date of Birth/Age Next Birthday 29/12/1997 (26) Sex MALE State of Origin EKITI Town of Origin ADO-EKITI Tribe YORUBA Religion Christian Marital Status Single Phone Number 0803-444-6881 Email cbgram8@gmail.com ENGINEERIN & Faculty ENVIRONMENTAL STUDIES Department AGRICULTURE ENGINEERING Programme B. Agricultural Engineering ‘Thursday 4th of May 2023 8am to 11am School Address OLOLO, SALOME AGO IWOYE OGUN STATE Home Address 2. CLOSED IMOLEAYO STREET ATIBA IJEBU ODE OGUN STATE Name of, Parent/Guardian MR OLADUNJOYE JIMOH Relationship FATHER ‘Address of Parent/Guardian Parent/Guardian Phone Number 0803-44-68 Parent/Guardian Email Name Clinic Verification Date 2, CLOSED IMOLEAYO STREET ATIBA IJEBU ODE OGUN STATE cbgram8@gmail.com what do you think your health status is? Have you ever been admitted as an in-patient into a hospital? Do you suffer or have suffered from tuberculosis?Do you suffer or have suffered from nervous disease? NO Do you suffer or have suffered from any respiratory disease? No Do you suffer or have suffered from allergies? No Do you suffer or have suffered from Schistosomaisis? No Do you suffer or have suffered from any disease of the ear? No Do you suffer or have suffered from any disease of digestive system? NO Do you suffer or have suffered from any disease of the Genito-Urinary system? nie) If there are any other details of your medical histroy, Please give particulars Is your family a healty one? YES Has any of your family members suffered from Tuberculosis? No Have you been immunised against Small Poxs No Give date of Tetanus Immunization lothers(Specify) Student Signature & Date Director of Health Services Copyright © 2023 Olabisi Onabanjo University, ICT TEAM] OOU - PORTAL by QOU-ICT