He/she has no disease or mental or bodily infirmity unfitting or likely to unfit him/ her in the future for active outdoor service marks of identification thumb impression dated (signature of gazetted medical officer) official seal signature of candidate paste a latest coloured passport sized. Form : 4 [see rule 19] medical certificate for leave or extension of leave or commutation of leave signature of the government servant form : 5 [see rule 24 (3)] medical certificate of fitness to return to duty signature of the government servant. Medical fitness a candidate must be medically fit to undergo the professional course applied for the medical fitness must be certified by a registered medical practitioner in the prescribed proforma, as given below on a letterhead : certificate of medical fitness this is to certify that i have conducted clinical. The form can be submitted or retained via the following criteria: for the applicant original (yellow) certificate of medical fitness must be given to applicant if requested, copy of medical examination report may also be given for the shp seafarer administration team duplicate (green) of the certificate of medical fitness and. Medical fitness certificate format : dated on: medical fitness certificate snehal patil uploaded by snehal patil connect to download get doc academiaedu.
How to complete this form please print this form or send a copy to your qualified medical practitioner for your appointment to accurately assess your medical fitness. Format of medical certificate for person with diabilities (pwd) name and address of the institute/ hospital___________________________________ certificate no. Please present your medical fitness certificate at the concerned nust college/ school at the time of joining medical standards for admission study at nust demands good physique and stamina an applicant must have sound health so as to bear the strain of the course signature of doctor with legible seal.
He / she has not given any personal history of any disease incapacitating him/ her to undergo the professional course also, on clinical examination it has been found that he/she is medically fit to undergo the professional course certified further, that he / she has not shown any evidence of major defects of posture. Form no4 indian institute of technology, roorkee roorkee medical examination report (to be issued by a registered medical practitioner) general expectations candidate will have good general physique with (a) chest measurement should not be less than 70 cm with satisfactory limit.
This is to certify that i have examined mr/ miss he/ she is suffering / not suffering from following diseases asthma diabetes hypertension fits / convulsions physical disability mental disability allergy & have undertaken all vaccination any other major disease (please specify) - i certify that mr / miss is physically. Form 1-a [see rules 5(1), (3), (7), 10(a), 14(d) and 18(d)] medical certificate space for passport size photograph [to be filled in by a registered medical practitioner appointed for the purpose by the state government or person declaration made by the applicant in form-1 as to his physical fitness is attached. Medical fitness certificate(to be signed by a registered medical practitioner holding a degree not below that of mbbs) (to be subm. Form no: ex/fo/016 medical fitness certificate this certificate is issued by the democratic socialist republic of sri lanka in compliance with the requirements of section 127 (1) (i) of the merchant shipping act, no 52 of 1971, and the merchant shipping (training, certification and watchkeeping) regulations no.
I also certify that before arriving at this decision, i have examined the original medical certificate and statement of the case (or certified copies thereof) on which leave was granted or extended and have taken these into consideration in arriving at my decision place: signature of government medical officer /civil surgeon. Physical examination for medical fitness certificate no ____/ ______/ dated mr/ms/mrs s/o, d/o, /w/o age ______sex ______ hiv anti hcv/hb ag's any other remarks: fit / unfit / deferred (to be signed and stamped by authorized medical officer of government hospital) page 1 of 1. Of registered medical practitioner / civil surgeon medical examination to be conducted: 1 physical examination 2 eye test 3 skin examination 4 compliance with schedule of vaccine to be inoculated against enteric group of diseases 5 any test required to confirm any communicable or infectious.