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  • Medical Form For Nim

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    vishal
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    This medical form collects medical information from applicants for mountaineering courses at Nehru Institute of Mountaineering. The form includes sections to document the applicant's present symptoms, past medical history, general physical exam, specific body system exams, and laboratory test results. The examining medical officer must certify whether the applicant is medically fit to undergo the requested mountaineering course. Both the applicant and guardian must also sign confirming no medical history was concealed.

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    medical form for nim

    Original Title

    Medical Form for Nim

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    This medical form collects medical information from applicants for mountaineering courses at Nehru Institute of Mountaineering. The form includes sections to document the applicant's present symptoms, past medical history, general physical exam, specific body system exams, and laboratory test results. The examining medical officer must certify whether the applicant is medically fit to undergo the requested mountaineering course. Both the applicant and guardian must also sign confirming no medical history was concealed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    205 views1 page

    Medical Form For Nim

    Uploaded by

    vishal
    This medical form collects medical information from applicants for mountaineering courses at Nehru Institute of Mountaineering. The form includes sections to document the applicant's present symptoms, past medical history, general physical exam, specific body system exams, and laboratory test results. The examining medical officer must certify whether the applicant is medically fit to undergo the requested mountaineering course. Both the applicant and guardian must also sign confirming no medical history was concealed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    NEHRU INSTITUTE OF MOUNATINEERING


    UTTARKASHI-249193 INDIA
    MEDICAL FORM (Certificate)
    Certificate by Medical Authority ( Put : - or + Numbers or Alphabets only)
    PRESENT Symptoms Illness
    PAST Injuries Operation
    HISTORY Allergies Cong. Defect
    Height (cms) Weight (kgs.)
    GENERAL Chest (Nrml) Chest (Exp)
    EXAM Pulse/min Resp. Rate/min.
    B.P.(mm Hg) Temp (0c)
    Vessls H Size
    H Rate/Min H Sounds
    CVS
    Rhythem JVP
    Perf Pulses Varicose Veins
    Br. Sounds Bilat Exp. Expansion
    LUNGS
    Trachea Br. Holding (Sec)
    Liver Spleen
    ABDOMEN Abnormal Mass Hernia
    Haemorrhoids Kidneys
    Bladder Testis
    URINARY SYSTEM
    Prepuce Hydrocoele
    Cranial N Motor F
    CNS
    Sensory F Mental F
    MC Abnormal MC
    O&G PMT PID
    LMP Obstertic
    Distant Vision R L Near Vision R L
    EYE
    I O T (mmH2O) R L Colour R L
    Ear Drums R L Hearing R L
    Wax R L Tonsils
    ENT
    Sinuses Epistaxis
    DNS Mucosa
    Teeth (No) Gums
    DENTAL
    Caries Filling
    Blood Group HB (gms%)
    BT (min/sec) CT (min/sec.)
    LAB Urine RE Spec. Gravity
    Sugar Albumin
    RBC Pus Cells
    VACCINE T.T (dt.) T.A.B. (dt.)

    Space to write any singnificant finding/advice.


    ___________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________

    Certified that I, on this dt. ___________ examined ___________________ age _________sex _______ Region __________________
    and found him/her medically fit to undergo _______________________________ mountaineering course.

    His/Her Blood Group is ________________

    Date _________________ Signature of MO


    Regd. No. & Designation

    Certificate by Trainee/ Guardian

    I Certify the I/ my ward did not conceal any part/present history of illness to the medical authority

    Signature of Guardian Signature of Trainee/Ward


    Date _____________ Dt. _________________

    (To be filled by Institute MO)

    1. ______________________________________ was examined by me and found fit/unfit to undergo _____________________


    course.
    2. Opinion of specialist, Dist. Hospital, Uttarkashi has been obtained towards medically unfit candidate.

    Date ________________ Medical Officer


    NIM Uttarkashi (UA)

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