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Physical Fitness Certificate

1. This document is a physical fitness certificate issued by a registered medical practitioner. It collects personal information about an individual such as name, age, sex, identification marks, and medical history. 2. The medical officer conducts an examination and records measurements of height, weight, and vital signs. They evaluate the respiratory, nervous, cardiovascular and gastrointestinal systems and check for any defects or illnesses. 3. The medical officer certifies that the individual, based on the examination, is in sound physical health and fit to pursue higher studies. Both the medical officer and examined individual sign the certificate.

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Vijendra R
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10K views1 page

Physical Fitness Certificate

1. This document is a physical fitness certificate issued by a registered medical practitioner. It collects personal information about an individual such as name, age, sex, identification marks, and medical history. 2. The medical officer conducts an examination and records measurements of height, weight, and vital signs. They evaluate the respiratory, nervous, cardiovascular and gastrointestinal systems and check for any defects or illnesses. 3. The medical officer certifies that the individual, based on the examination, is in sound physical health and fit to pursue higher studies. Both the medical officer and examined individual sign the certificate.

Uploaded by

Vijendra R
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Physical Fitness Certificate Form

PHYSICAL FITNESS CERTIFICATE

(To be issued by a Registered Medical Practitioner)


PERSONAL HISTORY
1. Name ..............................................................................................
2. Parent/ Guardians Name......................................................................
3. Age ...............................Years .................................... Months
4. Sex............................
5. Identification Mark on the Body, if any .......................................................................
(This can be a mole, scar or birthmark)
6. Major illness/ surgery, if any .............................................................
(Specify nature of illness/ surgery)

CERTIFICATE
(The following are to be filled by the Medical Officer conducting the medical examination)

1. Height ....................cm 2. Weight ............. kg


3. Past History 4. Chest
a) Mental Disease ..................... a) Inspiration .........cm
b) Epileptic Fit ......... b) Expiration ..........cm
5. Blood Group ............................. 6. Hearing...................
7. Vision with or without glasses
a) Right Eye.................................. b) Left Eye..................
c) Colour Blindness ........................ d) Uniocular Vision .........
8. Respiratory system ..................... 9. Nervous system .........
10. Heart 11. Abdomen
a) Sounds............................... a) Liver....................
b) Murmur .................. b) Spleen .................
12. a) Hernia ............................
b) Hydrocele ........................
13. Any other defects................................................................................

Certified that................................................................................................
Son/daughter of ..........................................................................................
is in sound physical health to pursue his/her higher studies.

Signature of the Medical Officer Signature of the Candidate

Date..........................................
Full Name....................................
Medical/Registration No. and Official Seal ............

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