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6 Vision (To be checkedby eye specialist)
(Please provide the exact values)

Rt Lt
Colour Vision (Pls V MarkApplicable)

Without glass Distance Normal Colour vision

blb blh
Near '1 Total Colour Deficiency
ru,
With glass Distance Partial Colour Defi ciency
Near If par{ial - pl. mention
Power oflens Spherical
Cylindrical
Axis

Yes
fv
No

Ea
Squint
Any other eye disease if yes pl. give details

7 Audiometry Report *l ermt <)

8 P.F.T Report ilor,n,U
9 Heart Sounds *t orru! Mur Present Absent Details ifpresent

Arteries
- Brood Pressure
(Please provide the exact values)
l;;;l@mm
L__:_f___l
hg
Sys Dia

Pulse-Rate
f-Ts ]r'n'" Character ken-^W
ro Lungs aoruO
rI r Abdomen A/ornr.t-{ Liver Spleen a tr4P
^[or"l-L/
1 2 Urinary and Genital Organs NOaP-l
Venereal Disease
t3 Special Conditions Varicose Veins
Hernia Deformities
Scars

Identification marks:
, 4en oa r)U-$,* h<-^eLt'
OA

L4 Nervous System Norrvttl h---:l----

Pupilary n---r:--
Reaction
Planters Knee Jerks Rhombers l-+re
"l l--r;l
I .1,
,.
rs Urine : Sp. Gr. I , 0 to Reaction PLl:Z"rbumin lvtI SugaryUr/
Microscopic (If required)
Blood Haemoglobin
(Pl€ase provide the exact
g% Blood Sugar
(Please provide the exact values)
FBS/RBS Bl. Gr. +ve -ve
valu6)
S. cholesterol mg% S. Trygly. mg% S. Crea t.
S. Bilirubin mg% SGPT units
16 Chest X-ray
17 E.C.G

r8 Any other Investigations / clinical finding ' 'I

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Reg,fic :107996
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