DISTRICT HEAD QUARTER HOSPITAL

MANDI BAHAUDDIN
No.______________ /DHQ. Dated.______/_____/2018.

MEDICAL FITNESS CERTIFICATE

It is certified that Mr / Mst. ________________________________________

S/o D/o W/o ___________________________________ Date of Birth ____________

Passport No. ________________________ CNIC No. __________________________

R/o DISTRICT MANDI BAHAUDDIN has been examined and investigated.

1. Anti HC _____________________________

2. Hbs Ag _____________________________

3. HIV _____________________________

4. HB _________________________/gm/dl

5. ESR _________________________mm/hr

6. VDRL/ Syphilis_____________________________

7. BSR _____________________________

8. Urine R/E _____________________________

9. X-Ray Chest _____________________________

10. T.B _____________________________

2. His / Her eye sight in the both the eyes is ____________________________

OPHTHALMOLOGIST
DHQ HOSPITAL
MANDI BAHAUDDIN
3. E.C.G Report _______________________________

CARDIOLOGEST
DHQ HOSPITAL
MANDI BAHAUDDIN
4. Mark of Identification of Candidate.
1. _______________________________

5. He / She is found physically and mentally fit at present to proceed abroad & He /
She is not suffering any of the diseases that may have serious public health impact
according to the provisions set forth by International Health Regulations 2005.

Specimen Signature of Candidate

_________________________

MEDICAL SUPERINTENDENT
DHQ HOSPITALM.B.DIN