MEDICAL CHECK UP SUMMARY / CERTIFICATE
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TO DATE
FILE NO CATEGORY BLOOD GROUP
PESONAL DETAILS
NAME
NATIONALITY AGE SEX
PASSPORT NO/IQAMA DATE OF BIRTH
EMPLOYMENT DETAILS
SPONSOR / COMPANY
JOB DESCRIPTION CITY
MEDICAL EXAMINATION
HEIGHT WEIGHT
PULSE B.P TEMP
°C
LUNGS & CHEST
CARDIO VASCULAR
NEUROLOGICAL
VISION N6 = NORMAL N6 = NORMAL
NEAR LEFT
FAR LEFT
RIGHT
RIGHT
WITHOUT GLASSES
HEARING LEFT RIGHT
GENERAL HEALTH CONDITION
APPEARANCE
IF SUFFERING FROM ANY CHRONIC DISEASES
ADDITIONAL COMMENTS IF ANY
NOTE: THIS MEDICAL FITNESS REPORT IS VALID TILL
DR. SHAHID HUSSAIN ()
ATTENDING PHYSICIAN
DR. SAEED ABDUL KHALIQ
MEDICAL DIRECTOR