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    Medical Form 2024

    Uploaded by

    clintonejekwu9

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Medical Form 2024

    Uploaded by

    clintonejekwu9
    3 views2 pages

    Original Title

    MedicalForm2024

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    Copyright:

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    3 views2 pages

    Medical Form 2024

    Uploaded by

    clintonejekwu9

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    COUNCIL OF LEGAL EDUCATION

    NIGERIAN LAW SCHOOL Medical Form


    ABUJA/LAGOS/ENUGU/KANO/YENEGOA/YOLA
    STUDENT’S PERSONAL DATA
    Bar Part II 2024/2025 Backlog Session

    Surname:

    Other Names:

    Phone No:

    Date of Birth:

    Name of Next of Kin:

    Address of Next of Kin:

    Next of Kin Phone No:

    Medical Data (to be filled by a Medical Doctor from a Government Hospital)


    1. (a) Height metres (b) Weight kg
    2. (a) Pulse (b) Blood pressure (c) Respiratory rate

    3. (a) Heamoglobin estimation: _


    (b) Genotype:
    (c) Blood group:
    (d) Clotting time: _

    4. Urine analysis

    5. Stool Analysis:

    6. Chest
    (a) X-ray (including report) :
    (b) Sputum test for AFB:

    7. Visual test
    rl (with glasses ) _
    rl (without glasses) _

    8. (a) HepatitisvBsAg
    (b) Hepatitis C Virus

    9. Do you have allergy? If yes, state

    10. Do you have the following? State yes or no


    (a) Asthma (b) Heart Disease
    (c) Hypertension (d) Epilepsy
    (e) Migraine (f) Depression
    (g) Tuberculosis (h) Diabetes
    (i) Blood Disorder (j) Liver Disease
    (k) Skin Diseases (l) Syncope
    (m) Physical Defect (n) Others Specify
    (o) Peptic Ulcer

    State reason (if any)

    11.11.
    Have you ever been hospitalized? If yes state Reason(s)

    12. Have you ever had blood transfusion? If yes state reason(s)

    13. State any physical, medical or surgical problem (apart from those already listed) that may
    interfere with your academic work during your stay in Law School:

    14. State the last time you were immunised against the following diseases.
    (a) Cerebrospinal meningitis Yellow Fever

    15. Full name and address of government hospital with official stamp.

    Signature of Medical Officer

    Full name

    Date

    NB: Read Carefully

    (1) The medical data portion of this form is to be completed , signed and
    stamped by a Medical Practitioner from a government hospital.
    (2) All completed forms duly signed and stamped, should be returned with the following:
    (a) Chest X-ray with report
    (b) Laboratory investigation result

    (3) Accommodation shall only be given when the above have been complied with.
    (4) Information disclosed in this form will not adversely affect your chances of
    getting admission; it will only assist the Medical Personnel in the discharge of
    their duties.
    (5) Completed copy of this form is to be brought to the NLS after you have
    been offered admission.

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