Meem Group

Pre-Employment Medical Examination

Name :…………………………………………………………………………………………………………...……………………………………..………………………….

Designation
:…………………………………………………………………………………………………………………………..………………………………………………….
Date of Birth (DoB)
.…….……………..………………DD ……...…..…..…….…..MM …..……….…………….. YYYY Age: ………………….…..Years
Gender
Nationality Male
Material Status :………………………………………………...…………………………………………………………………………………………………………….

Height Unmarried
:…………………………………………………………………………………………………………...………………………………………………….…………….
Weight
:………………………………………………………………………………………………..………………………...………………………………………………….
National ID Card/Passport
Ha- :…………………………………………………………………………………………………………...…………………..…………………………………………… .
Medical / Physical Examination Laboratory Examination
Eye……………………………………………………………….………….……………….. 1. Urine R/E 5

Ear……………………………………………………………….…………………………….. M/E 5

Blood Pressure…………………….……………………….……………………… 2. Stool R/E 5

Heart…………………………………………………………………………………………. M/E 5

Lungs………………………………………………………………………………………… 3. Blood Blood Group 5

Chest X-ray…………………………………………………………………………….. Haemoglobin 5

Abdomen……………………………………………………………………………….. 4. Serology RBS 5

Skin…………………………………………………………………………………………... LFT 5

Any Deformaties……………………………………………………………...…. Creatinine 5

CNS…………………………………………………………………………………………... 5. Elisa HIV I & II 5

Psychiatry……………………………………………………………………..………… Hbs Ag 5
Identification Mark………………………………………………………...…. Anti HCV 5
Others…….………………………………………………………………………………. 6. VDRL Test

Please Mark: Medically Fit 5 Unfit 5

Remarks: …………………………………………………………………….……………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

Name & Signature

Medical Officer

D:\Work\Recruitment & Selection\Joining Kit\New folder\2 Pre-EmploymentMedical ExaminationMedical Form 03