MEDICAL EXAMINATION FOR ALL RECRUITS

Tobe filled up at the time of recruitment:

Ref. No…………………………………… Date: ……………...

Name: S/o D/o Sex:

Present Address: At: Post: _____________ PS: __________ Dist.: ___________ State: __________
Place of birth : Date of Birth: Age:
Identification Marks: _____________________________________________Married / Unmarried: ______________

Medical History: Syph / Gon. K.A., T.B., Malaria, Epilepsy, Diabetes / Asthma
'A' PRESENT CONDITION:
1. GENERAL: 5. ABDOMEN:
a) Appearance a) Stomach & Duodenum
b) Height b) Liver
c) Weight c) Spleen
d) Chest- Before Expansion ____________ d) Glands
After Expansion ____________ e) Miscellaneous (Colitis, etc.)
e) Abdominal girth
f) Hips 6. E X T R E M E N T S & B R A I N :
g) Temperature (Oral) a) Muscles
2. FACE & OROPHARYNX: b) Nerves - Cranial
a) Eyes (Vision) ______________ (Tension) - Spinal
(If wearing Glass :) - Others
- Power RE_______ LE _______ c) Bones
Colour Blind : Yes / No d) Joints - Deformity
b) Ear - Hearing Normal / Defective e) Miscellaneous
Discharge
7. M E N T A L C O N D I T I O N :
c) Nose - Discharge Septum
d) Throat & Mouth Pyorrhea caries pharyngitis, Septic
Enlarged Tonsils. 8. OTHERS:
e) Oropharynx a) Inguinal Canal (Potency)
f) Miscellaneous b) Scrotum
3. THORAX: c) Tests
a) Heart Size Apex beat _____________ d) Miscellaneous
Palpitation.
b) Heart's sound, Normal / Abnormal (Ectopai 9. Addiction to any Narcotics e.g., Tobacco & Alcohol.
beats)
c) Lungs : Percussion Auscultation 10. Skin - Thickening of nerves, naesthetic areas
d) Sign of : Asthma / Bronchitis / Pleurisy / depigmentation.
Tuberculosis.
4. CIRCULATORY SYSTEM:
a) Pulse: Rate, Rhythm, Vol. Tension.
b) Blood pressure , Syst / Diast : _________
After Exercise.
c) Anemia.

'B' INVESTIGATIONS WHENEVER AND WHEREVER CONSIDERED NECESSARY:

I. BIOCHEMICAL II. RADIOLOGICAL III.
1. Blood - (a) Group (b) VDRL 1. Fluoroscopy 1. Chest X - Ray
(c) FBS (d) HIV
2. Stool 2. Radiography 2. Audiometry
3. Urine 3. Electro - Cardiography
4. Sputum

CLASSIFICATION: A,B,C,D. Fit / Unfit For Employment

Any other Remark if necessary

Signature of Medical Officer

Regd. No. ________ State: _________