EXAMINATION OF DRUNK

PERSON
Dr. Vishal B. Surwade
MBBS, MD, MBA(HA)
Professor
 Examination / Report of Alleged Alcoholic

To,
The Investigating Officer, P.S.
Reference: Your letter No.______, Dated: _____
I am forwarding herewith the result of
examination of-
Name:________________________________
Son / daughter / wife / widow of ___________
Age: _____years, Sex: M/F, Weight:
___kg
Address:________________________________
________________________________________
Consent for examination:

Signature / Thumb impression

Identification Marks: 1.
2.
Brought by P.C. Name: __________ ,No.___ , P.
S. ___________
Date and time of examination: _____________
General behavior:
Memory: __________ Mental alertness:_________
Pulse: ____________ Respiration: _____________
Temperature: _______ Blood pressure: _________
Skin: __________________
Smell of alcohol from breath, if any:
____________
Eyes: _____________ Pupils: __________________
Muscle co-ordination: ________________________
Gait: _______________ Speech: _______________
Handwriting: _______________________________
Reflexes: __________________________________
Systemic examination-
Respiratory System:______________________
Cardio-vascular System: ___________________
Gastro-intestinal Tract: ____________________
Laboratory investigation: - Blood: ___________
Urine:
___________
Expired air: ______________________________
Opinion: I am of the opinion that-
1. The above person has NOT CONSUMED ALCOHOL.
2. The above person HAS CONSUMED ALCOHOL AND IS NOT UNDER ITS
INFLUENCE.
3. The above person HAS CONSUMED ALCOHOL AND IS UNDER ITS
INFLUENCE.
Place: _______________Signature: _____________
Date & Time:_________ Doctors Name:__________
Post: _______________ Qualification:____________
Name & Address of Hospital:____________________
Reg. No.:__________________
Stamp: _____________________
Drunkenness Certificate

28 year old male was brought to this

hospital by Police for examination
yesterday night, with alleged history of
creating nuisance to his neighbors after
consuming alcohol on yesterday evening.
Issue a necessary Certificate.
(Assume / presume data wherever
required.)
Kaun kambakht bardasht karne ke
liye pita hai..........????

1/20/2024 Forensic medicine 8

 Examination / Certification of Alleged
Alcoholic

To,
The Investigating Officer, P.S.
Reference: Your letter No.147/23, Dated:
05/01/2023
I am forwarding herewith the result of
examination of-
Name: Mr. Devdas Mukherji
Son / daughter / wife / widow of Narayan
Mukherji
Age: 28 years, Sex: M/F, Weight:62kg
Address: Krishna Kunj, Kali Ghat, Bengali
Chauraha, Indore – 452010.
Consent for examination: I ……………………………………………
hereby give my consent to Medical Officer for
medical examination to determine consumption of
drugs/alcohol and their effects. I further consent to
divulge the findings to the police and to the courts.
Signature / Thumb impression:
Identification Marks: 1. ____________________
2. ____________________
Brought by P.C. Name: Mr. Solanki ,No.1466 , P.S.
Banganga Police station, Indore.
Date and time of examination: 05/01/2023; 9:30pm
General behavior:
Drowsiness & Dizziness Present, Disoriented.
Memory impaired; Mental alertness: markedly confused
Pulse: 110 beats/min Respiration: 20 cycles/min
Temperature: 98.8 F Blood pressure: 116/84mmHg
Skin: Flushing present
Muscle co-ordination: impaired
Tests for Muscle Co-ordination: Finger to Finger test; Finger to
Nose test; buttoning & unbuttoning of Shirt.
Smell of alcohol from breath, if any: Present
Eyes: Reddish, swollen, Pupils: Semi dilated, reacting to light
Gait: Staggering Speech: Thickened
Handwriting: Distorted Reflexes: Sluggish
Systemic examination-
Respiratory System: B/L Air entry normal &
clear
No abnormality detected
Cardio-vascular System: S1S2 normal,
No abnormality detected
Gastro-intestinal Tract: Distended, Liver Just
palpable, Superficial veins visible & tortuous.
Laboratory investigation: - Blood: report
awaited
Urine: report
awaited
Expired air: Contains odor of Alcohol
Opinion: I am of the opinion that-
(1) The above person has not consumed alcohol.
(2) The above person has consumed alcohol and is not under its influence.
(3) The above person has consumed alcohol and is under its influence.
Place: Sanwer, Indore
Signature: Dr. XYZ
Date & Time: 05/01/2023; 10:30pm
Doctors Name: Dr. XYZ
Post: _______________ Qualification: MBBS
Name & Address of Hospital:
Sri Aurobindo Medical College & PG Institute, Indore
Reg. No.:________________
Stamp: _________________
Physiological Effects of Alcohol
Drunkenness Certificate

28 year old Male was brought to this

hospital by Police for examination today at
4am, with alleged history of driving after
consuming alcohol. He was oriented with
time & place. He was able to walk with
steady gait & his speech was not slurred.
Issue a necessary Certificate.
(Assume / presume data wherever
required.)
THANK YOU