STAFF CLINIC (NHIS NO.

YB/0033/P)

TO WHOM IT MAY CONCERN

RE-MEDICAL CERTIFICATE OF FITNESS
A. Personal Data

(1) Full Name: Olusunkanmi Ogundijo Sunday

(2) Sex: Male Age: 22 years old

(3) Marital Status: SINGLE Nationality: Nigerian

(4) State: Osun L.G.A: Odo-otin

(5) Telephone: 07031491377 Email:

ogbrightsunny33@gmail.com

(6) Place of Birth: OSUN

(7) Contact Address: POTISKUM

This is to certify that the above named has undergone medical examination of fitness with the
following findings

B. MEDICAL HISTORY

Hypertension Yes/No Tuberculosis Yes/No

Diabetes Yes/No Asthma Yes/No
Heart Disease Yes/No Sickle Cell Disease Yes/No
Kidney Disease Yes/No Others (specify) _______________________

C. PHYSICAL EXAMINATION

Cadiovascular System PR:_________________________________BP___________________________________

Gastro Intestinal Sysyem:_______________________________________________________________________
Central Nervous System:________________________________________________________________________
Muscular Skeletal System:______________________________________________________________________
Ear/Nose/Throat: ________________________________________________________________________________
Eye Vision: RE______________________________________LE____________________________________________

D. LAB0RATORY INVESTIGATION

Haemoglobin:____________________________________________________________________________________
Blood Group:_____________________________________________________________________________________
Elisa Test:________________________________________________________________________________________
Urine Analysis:______________Sugar____________Protein_______________Microscopy______________
Stool Microscopy: _______________________________________________________________________________
Comment_________________________________________________________________________________________
Signature/Date:__________________________________________________________________________________
Name of Medical Officer:________________________________________________________________________

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