URRE

NAME ADDRESS OFTHE (NSTITUTE HOSPITAL

Certificte No. 18,[2.0. Date:15|G|2o
DISABILITY CERTICATE

Tais is to certity tht Shri Snt / Kurn. Kamlshkuu Robisontwife/daughier of Shri

ile AKhu Age: 22Sex mule identfication mark (s) is suffering from
pennanent disability of foílowing category :

Locomotor er cerc ral palsy:

BL Both Cegs affected but not arms
BA Both arms affected
(a)Impaired reach
(b) Weakness of grip
Ci) BLA Both lcgs and boi arms afectod
OL One leg affected (dpier lef1 (a Impairedreach
6 Weakness of grip
()Ataxjc
OA -One arrm afecued (Legt A inipaired répetDr.GD Patel(G-14931
6 ) Weakneas of grip CO Cum Civ Surgeon
(c) Ataxic
vi) BH-Sifft back and hips (cannnot sit or stcop) General Hospital,Pilad[Anand)
(vi) MW -Mu:cular weakness and linited physical
endorance..
B. Bliadness or Low Vision )B-BIi
Ci) PB - Partially Blind

C Hearirg Impairment. ) D - Deaf

i ) PD - Partially Deaf

(DELETE THE CATEGORY WHICHEVER IS NOT APPLICABLE). :

2. This conditioar is sregressive i
non-progressive / likely to impreve/not likely to improve
ssessncatcf this case is notrecommended laeeeeneaded after a period of_
years
dhs. (Strik ou which is .1ot applicable).
3 Percentáge of diability in hisher case is O Peccen. FovPH)
4. Shril/ Sent / Kum.Komesh kunu meets the following physical requirements for discharge
of bis/ber duties
F-can perform work by manipulatiag with fingures YesNo
PP-canpesform wock by puBling and pushing YesNel
L-can perform work by lifting Yes/Noi
iv) KCcan perform work by kncclinig and cratching YesNe
B-can perform work by bending
S-can perform wofk by sitting (oa bench or chair) Yes/No
Yes/Ne
(vii)ST-can perfom work by standing Yes/No
(vin) W-can perform work by walking
MehammadjunaidShajKh
SE-can perform wark by seeing
can perfom work by henring/speaking
RWcan perform work by reading aad writing en(eGr-a2Hol7727)spitaPl,Aiad(Anand)
UresNe
rthopedic
Yes/Ne Surgepí
Yes
. o m a 1 2 1 )c L
CL-I
gepm
CL-1

OrthopedicSurg
SrteddcaatelG:14937)

General Hospital,Petlad{Anand)