Nothing Special   »   [go: up one dir, main page]

Form IX PDF

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

Form - IX

MEDICAL CERTIFICATE
(to be issued by a Registered Medical Practitioner)
GENERAL EXPECTATIONS
Candidates should have good general physique. In particular,
1. Chest measurement should not be less than 70 cm, with satisfactory limits of expansion and contraction.
2. Vision should be normal. In case of defective vision, it should be corrected to 6/9 in both eyes or 6/6 in
the better eye. Colour blind and uniocular (having vision in only one eye) persons are restricted from
admission to certain courses.
3. Hearing should be normal. Defective hearing should be corrected.
4. Heart and lungs should not have any abnormality and there should be no history of mental illness and
epileptic fits.

1 Name of the candidate:

2 Identification Mark (a mole, scar or birthmark), if any

3 Major illness/operation, if any (specify nature of illness/operation)

4 Height in cm: Weight in kg: Blood Group:


5 Past History (a) Mental illness
(b) Epileptic Fit
6 Chest (a) Inspiration in cm (b) Expiration in cm
7 Hearing
8 Vision with or Right Eye Left Eye Colour Blindness Uniocular vision
(having vision in only one eye)
without glasses:
9 Respiratory System

10 Nervous System

11 Heart (a) Sounds (b) Murmur


12 Abdomen Hernia Hydrocele
(a) Liver
(b) Spleen
13 Any other defects:

Certificate of Medical Fitness


The candidate fulfils the prescribed standard physical fitness, medical fitness and is FIT
for admission to Engineering/Architecture/ Pharmaceutics/ Science Course
The candidate does not fulfil the prescribed standard of physical fitness/medical fitness
and is unfit/temporarily unfit for admission due to following defects:

_______________ ________________ __________________ _________________


Name of the Doctor Signature Registration number Seal

You might also like