NAME OF THE COLLEGE: Shri V. M.

Mehta Institute of Ayurved, Anandpar

GUJARAT AYURVED UNIVERSITY

JAMNAGAR – 361008
Accredited Grade “A” by NAAC (CGPA 3.28)

Fourth Year Ayurvedacharya (B.A.M.S.)

Kayachikitsa Department
Journal

Academic Year: 2023 - 2024

Name of Student:
Roll No.:
Examination Seat No.:
 Affiliated

Shri V. M. Mehta Institute of Ayurved - Anandpar

CERTIFICATE
Exam No.

This is to certify that 4th Year B.A.M.S. Student……………………………………………….

Roll No. …………… has completed practical’s/clinics of KAYACHIKITSA under our
supervision and has documented 20 case history forms here in, we here by certify that the
authenticity of this record.

Date: ______________
Place: ______________

Signature of Teacher Signature of HOD Signature of Principal

Signature of Examiner

1)

2)
 GUJARAT AYURVED UNIVERSITY, JAMNAGAR
Affiliated
Shri V. M. Mehta Institute of Ayurved, Anandpar

Name of Student _____________________________________________

Year of Examination _________________________ Roll No ______
Department ________________________________

INDEX OF CLINICAL PROFORMA

NO. Name of Patient Diagnosis DOA DOD
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

Signature of Student Signature of Teacher Signature of H.O.D