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REPORT OF THE MEDICAL EXAMINERS - (DISTT.

MEDICAL BOARD)

NAME OF THE CANDIDATE : …............................................... FATHER’S NAME……...……...……...

CATEGORY OF THE POST : ..............................................................(IBPS CRP RRB XIII)

INSTITUTION/DEPARTMENT : CHHATTISGARH RAJYA GRAMIN BANK,CORPORATE OFFICE NAVA RAIPUR

(C.G.)

1. General Development : Good ......... Fair ......... Poor .......

Nutrition : Thin ......... Average ......... Obese .........


Best weight : .................. When ..................
Any recent change
in weight : ..................

Temperature : ..................

Girth of chest : ..................

(a) After full inspiration :

(b) After full expiration :

2. SKIN : Any obvious disease

3. EYES :

(a) Whether the vision is normal : Yes/No.


If not, is it capable of
being corrected to 6/6 with
glass (not with contact lenses)

(b) If the candidate was


referred to an eye-surgeon
what are surgeon's
observations in respect
of the following :

(i) Any disease

(ii) Night blindness


(iii) Defect in colour vision

(iv) Field vision

(v) Visual acuity

(vi) Fundus examination

Acuity of vision Naked eyes With glasses Strength of glasses


Sph. Cyl. Axis

Distant Vision
R.E.
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L.E.

Near Vision R.E.


L.E.

Hypermetropia
(Manifest)
R.E.
L.E.

4. EARS :
Inspection...............................................
Hearing : Right Ear ............................................
Left Ear ..............................................

5. GLANDS : ........................................... Thyroid .........................................

6. CONDITIONS OF TEETH : ............................................................

7. RESPIRATION SYSTEM :

Does physical examination reveal anything abnormal in the respiratory organs?

........................................................................................................................... If

yes, explain fully ......................................................................................

...........................................................................................................................

8. CIRCULATORY SYSTEM :

(a) Heart : Any organic lesion? ......................………............................

Pulse Rate : .............................................................................................. (b)

Blood Pressure : ............................................................................……

Systolic ....................................................................................................

Diastolic ...................................................................................................

9. Abdomen : Girth ................................ Tenderness …...................................

......................................................... Hernia .......................................... (a)

Palpable : Liver .......................... Spleen .............................................

Kidneys ...................................... Tumors ................................... (b)

Hemorrhoids .............................. Fistula ......................................


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10. NERVOUS SYSTEM : Indication of nervous mental disabilities ..............

......................................................................................................................

11. LOCO-MOTOR SYSTEM : Any abnormality ............................................

.................................................................................................................…

12. GENITO URINARY SYSTEM:Any evidence of Hydrocele, Varicoecele, etc

……………………......................................................................................

Urine Analysis :

(a) Physical appearance........................ (b)Sp.Gr. ................................

(c) Albumin ....................................... (d)Sugar ....................................

(e) Caste ................................………(f) Cells ...............................

13. REPORT OF X-RAY EXAMINATION OF CHEST :

................................................…................................................................

................................................…...................................................................

14. REPORT OF THE BLOOD EXAMINATION : (Including HIV Testing)

................................................…...................................................................

.................................................…...................................................................

15. Is there anything in the health of the candidate likely to render him/her unfit for the
efficient discharge of his/her duties in the service for which he/she is a candidate?

16. The Medical Examiner should Record the findings under one of the following
categories : (a) Fit
(b) Unfit on account of

NOTE :

In the case of a female candidate, if it is found that she is pregnant, she should be
declared temporarily unfit.

Signatures of the Members

1) 2) 3)

Signature of the Head of the Board


Name & Seal : .......……..........................
Designation

Place : ................................
Date : ..................................

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