5. Medical New
5. Medical New
5. Medical New
MEDICAL BOARD)
(C.G.)
Temperature : ..................
3. EYES :
Distant Vision
R.E.
---2---
L.E.
Hypermetropia
(Manifest)
R.E.
L.E.
4. EARS :
Inspection...............................................
Hearing : Right Ear ............................................
Left Ear ..............................................
7. RESPIRATION SYSTEM :
........................................................................................................................... If
...........................................................................................................................
8. CIRCULATORY SYSTEM :
Systolic ....................................................................................................
Diastolic ...................................................................................................
......................................................................................................................
.................................................................................................................…
……………………......................................................................................
Urine Analysis :
................................................…................................................................
................................................…...................................................................
................................................…...................................................................
.................................................…...................................................................
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.
1) 2) 3)
Place : ................................
Date : ..................................