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    This medical certificate document contains sections to record a patient's personal and medical information such as name, age, address, blood group, eyesight, hearing, cardiac and medical history, allergies, accidents, physical examination notes, and the examining medical officer's name and date. The form is to be completed by a government medical doctor and recommends the patient be examined in a government hospital.

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    This medical certificate document contains sections to record a patient's personal and medical information such as name, age, address, blood group, eyesight, hearing, cardiac and medical history, allergies, accidents, physical examination notes, and the examining medical officer's name and date. The form is to be completed by a government medical doctor and recommends the patient be examined in a government hospital.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    3 views2 pages

    Letter Head

    Uploaded by

    Unknown Unknown
    This medical certificate document contains sections to record a patient's personal and medical information such as name, age, address, blood group, eyesight, hearing, cardiac and medical history, allergies, accidents, physical examination notes, and the examining medical officer's name and date. The form is to be completed by a government medical doctor and recommends the patient be examined in a government hospital.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 2

    MEDICAL CERTIFICATE (TO BE COMPLETED BY A GOVERNMENT

    MEDICAL DOCTOR) ANNEX 2

    NAME…………………………………………………………………………………………
    ………………………………………………..

    AGE……………… ID.
    NO………………………………………………………………………………………………
    …………………..

    ADDRESS………………………………………………………………………………………
    ………………………………………………

    BLOOD
    GROUP…………………………………………………………………………………………
    ………………………………….

    EYES VISUAL
    ACUITY………………………………………………………………………………………
    ……………………………

    COLOURED BLIND……………………………………………………………………
    VISUAL………………………………………

    EARS SOUND PERCEPTION………………………………………………


    RIGHT……………………………………………….

    CARDIAC
    NORMALITY/HISTORY……………………………………………………………………
    ……………………………

    MALARIA……………………………………………………………………………………
    ……………………………………………..
    TUBERCULOSIS……………………………………..ANY
    ALLERGY…………………………………………………………….

    ACCIDENT
    HISTORY…………………………………………………………….HERNIA………………
    …………………………

    SKIN…………………………………………………….ANEMIA
    HISTORY……………………………………………………..

    PHYSICAL
    DEFORMITIES………………………………………………………………………………
    …………………………..

    GENERALCOMMENTS………………………………………………………………………
    …………………………………………………………………………………………………
    ………………………………………………………………………………………….

    NAME OF THE MEDICAL


    OFFICER………………………………………………………………………………………
    …………

    DESIGNATION……………………………………………………………
    DATE………………………………………………………

    NB: YOU SHOULD BE EXAMINED IN A GOVERNMENT HOSPITAL

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