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1. Are you currently being treated by a health professional for any illness or injury? P
9 . Have you ever had any serious injury, illness,operation, or been in hospital for any reason? P
Patient Name: Samadhan Shashikant Bhoi Joining Date: NA Checkup Date 17-Jul-21
Designation : NA D.O.B./AGE 5-Jun-91 Valid Till - 17-Jul-22
Emp Code: NA Gender Male
Address: Maharashtra Blood Group B+
Certificate No. US/MC/13487/21
Clinical Examination/Lab Test
1- Cardivascular System
BMI 21.05
Height 173 Weight 63
2- Blood Pressure - (Repeat if necessary)
Systolic 117 mmHg mmHg
Diastolic 78 mmHg mmHg
b- Pulse Rate Regular P Irregular
c- Heart Sounds Normal P Abnormal
d- Peripheral Pulses Normal P Abnormal
3- Chest/Lungs Normal P Abnormal
4- Abdomen (Liver) Normal P Abnormal
5- Neurological/Locomotor
a- Cervical Spine Rotation Normal P Abnormal
b- Back movement Normal P Abnormal
c- Upper Limbs
Apperance Normal P Abnormal
Joint Movements Normal P Abnormal
d- Lower Limbs
Apperance Normal P Abnormal
Joint Movements Normal P Abnormal
e- Reflexes Normal P Abnormal
f- Rombergs sign Normal P Abnormal
A pass requires the ability to maintain balance while standing with shoes off, feet together side by side, eyes
closed and arms by sides, for 30 seconds
4 Gender : Male
5 DOB/AGE : 5-Jun-91
6 Fitness : FIT
has been examined by us, We can not discover that he/she has got any disease, communicable or otherwise, constitutional or bodily
deformed or Vertigo.
DMC/R/11428