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  • IIMU MBA 2020 A10 Health Status Form

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    Aayoush Gupta
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    This document is a health status form for MBA students from the 2020-2022 batch. It collects information such as the student's name, contact details, medical condition, details of their consulting doctor, current medications, and any emergency procedures or support needed from the institute. The form is signed by the student and includes a section for office remarks.

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    This document is a health status form for MBA students from the 2020-2022 batch. It collects information such as the student's name, contact details, medical condition, details of their consulting doctor, current medications, and any emergency procedures or support needed from the institute. The form is signed by the student and includes a section for office remarks.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    17 views1 page

    IIMU MBA 2020 A10 Health Status Form

    Uploaded by

    Aayoush Gupta
    This document is a health status form for MBA students from the 2020-2022 batch. It collects information such as the student's name, contact details, medical condition, details of their consulting doctor, current medications, and any emergency procedures or support needed from the institute. The form is signed by the student and includes a section for office remarks.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Annexure 10

    HEALTH STATUS FORM


    MBA Batch 2020-22
    1. CAT Reg. No. : _____________________________________________
    2. Name of the student : _____________________________________________
    3. Contact Number of Student : _____________________________________________
    4. Mother’s Name : _____________________________________________
    5. Father’s Name : _____________________________________________
    6. Contact Number of Mother/ Father : _____________________________________________
    7. Description of Medical Condition : _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________
    8. Name and details of consulting doctor : _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________
    9. Current prescribed medication : _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________
    10. Does the condition presents with any : _____________________________________________
    emergency scenario? If yes, details _____________________________________________
    thereof and suggest measures to be _____________________________________________
    taken at that time _____________________________________________
    ____________________________________________
    11. Any support expected from : _____________________________________________
    the Institute to overcome the challenges _____________________________________________
    faced due to such medical condition
    (Signature of the student, with date)

    For Office Use: Remarks

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