<%@ Import Namespace="Vicis.

Helpers" %>
<%@ Import Namespace="Vicis.Models" %>
<% var fit = Model.Conclusion.Type == PatientConclusionType.Fit || Model.Conclusion.Type ==
PatientConclusionType.FitWithRestriction; %>
<% var unfit = Model.Conclusion.Type == PatientConclusionType.TemporaryUnfit ||
Model.Conclusion.Type == PatientConclusionType.Unfit; %>

LETTER OF FITNESS TO ENTER TOURISM or MARITIME SCHOOL / ACADEMY

PARTICULARS
Name <%= PropertyHelper.GetName(Model, "FULL") %>
Date of Birth <%=
PropertyHelper.FormatDate(Model.Detail.BirthDate, <%
"dd/MM/yyyy") %> Image(Propert
Principal / Manning Agent <%= Model.Detail.Client.Name %> yHelper.GetPh
Occupation / Rank <%= PropertyHelper.GetJobPosition(Model, true) %> otoPath(Model
Passport No. <%= Model.Detail.PassportNumber %> ), 50); %>
Examination Date <%=
PropertyHelper.FormatDate(Model.RegistrationDate,
"dd/MM/yyyy") %>

This is to certify that he / she has done ILO/MLC seafarer medical fitness assessment at our clinic
with result:
<% if (fit) { %>FIT<% } %>
<% if (unfit) { %>UNFIT<% } %>
Vital Signs
Height (H) <%= Respiration Rate <%=
PropertyHelper. PropertyHelper.GetPr
GetPropertyValu opertyValue(Model,
e(Model, "pe_vital_signs_respi
"pe_vital_signs_ ratory_rate") %> / mt
height") %> m
Weight (W) <%= Pulse Rate <%=
PropertyHelper. PropertyHelper.GetPr
GetPropertyValu opertyValue(Model,
e(Model, "pe_vital_signs_pulse
"pe_vital_signs_ ") %> / mt
weight") %> kg
BMI = W÷H² <%= Blood Pressure <%=
PropertyHelper. PropertyHelper.GetPr
GetPropertyValu opertyValue(Model,
e(Model, "pe_vital_signs_systo
"pe_vital_signs_ lic") %> / <%=
bmi") %> PropertyHelper.GetPr
opertyValue(Model,
 "pe_vital_signs_diast
olic") %> mm Hg

No Declaration of the recognized medical practitioner Yes No

1 Confirmation that identification documents were checked at the point of
✔
examination
2 Hearing meets the standards in STCW Code, section A-I/9? <
%
if
(Pr
< op
ert
%
if yH
(Pr el
pe
op
ert r.G
yH et
St
elp
er. cw
Ge Au
di
tSt
cw o
Au m
etr
dio
me yA
try ve
ra
Av
era ge
ge( (M
od
Mo
del el)
)< >
=
40)
{>✔% 40
<} {)
%
%% >
> ✔
<
% }
%
>
3 Unaided hearing satisfactory? <
%
if
(Pr
<
% op
ert
if
(Pr yH
el
op
ert pe
r.G
yH
elp et
Au
er.
Ge di
o
tA
udi m
etr
om
etr yA
ve
yA
ver ra
ge
ag
e( (M
od
Mo
del el)
>
)40)
< =
40
{%
>✔ {)
% <} %
>
%
> ✔
<
% }
%
>
4 Visual acuity meets standards in STCW Code, section A-I/9? < <
% %
= =
Pro Pr
per op
ty ert
Hel yH
per el
.Ge pe
tPr r.G
op et
erti Pr
es op
No ert
rm ies
 N
or
m
ali
ty(
alit
M
y(
od
Mo
el,
del
3,
, 2,
"p
"p
e_
e_v
vis
isio
io
n_r
n_
igh
rig
t_d
ht
ist
_di
ant
sta
_u
nt
nai
_u
de
na
d",
id
"p
ed
e_v
",
isio
"p
n_l
e_
eft
vis
_di
io
sta
n_l
nt_
eft
un
_di
aid
sta
ed
nt
")
_u
%
na
>
id
ed
")
%
>
5 Colour vision meets standards in STCW Code, section A-I/9? < <
% %
 =
Pr
op
= ert
Pro yH
per el
ty pe
Hel r.G
per et
.Ge Pr
tPr op
op ert
erti ies
es N
No or
rm m
alit ali
y( ty(
Mo M
del od
, 2, el,
"p 3,
e_e "p
yes e_
_is ey
hih es
ara _is
_te hi
st") ha
% ra_
> tes
t")
%
>
6 Physical abilities meet standards in STCW Code, table B-I/9? < <
% %
= =
Pro Pr
per op
ty ert
Hel yH
per el
 pe
r.G
et
.Ge Ex
tEx a
am m
Pro Pr
per op
tie ert
sN ies
or N
ma or
lity m
(M ali
od ty(
el, M
2, od
"p el,
e_ 3,
ba "p
ck_ e_
ext ba
re ck
mit _e
ies xtr
") e
% mi
> tie
s")
%
>
7 Are the laboratory results within normal limits? < <
% %
= =
Pro Pr
per op
ty ert
Hel yH
per el
.Ge pe
tEx r.G
am et
 Ex
a
m
Pro
Pr
per
op
tie
ert
sN
ies
or
N
ma
or
lity
m
(M
ali
od
ty(
el,
M
2,
od
"la
el,
b")
3,
%
"la
>
b")
%
>
8 Is Chest X-Ray within normal limits? < <
% %
= =
Pro Pr
per op
ty ert
Hel yH
per el
.Ge pe
tEx r.G
am et
Pro Ex
per a
tie m
sN Pr
or op
ma ert
lity ies
(M N
od or
el, m
2, ali
 ty(
M
od
"ra el,
d_x 3,
ray "ra
") d_
% xr
> ay
")
%
>

Conclusion:
<% if (fit) { %>He / She is Medically FIT to enter education in Tourism or Maritime School /
Academy. <% } %>
<% if (unfit) { %> He / She is Medically UNFIT to enter education in Tourism or Maritime School /
Academy. <% } %>

Date <%=
PropertyHelper.FormatDate(Model.RegistrationDate,
"dd/MM/yyyy") %>
Name of the medical examiner Debby Sartika Mahardhika, M.D.
Signature

Copyright © 2016 by Vidya Medika Clinic