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    Procedure

    MEDICAL REPORT


    Serial No

    Last Name : ………………………….

    Height : ………….Ft………..In……….

    Sex : ……………………………………

    Age : ………..

    Passport No : ………………………

    Position applied for : ……………………

    History of any significant past illness including:

    1.) Psychotic and neurological disorders

    (Epilepsy. depression. Schizophrenia……

    2.) Allergy 3.) Others

    First Name :……………….

    Wt ……. Lbs ………

    Status : ……………..

    Nationality : …………

    Place of issue : ………..

    Recruiting Agency…………………….


    I hereby permit the………………..and the undersigned physician to furnish such information the company pertaining to my health status and other pertinent and medical findings and do hereby release them from any and all legal from my employment benefits and claims.

    Signature of Examinee ……………………….


    1. MEDICAL INVISTIGATONS

    TYPE OF MEDICAL EXAMINATIONS

    RESULTS

    Rt

    EYE …………. ……….

    Lt

    Rt

    EAR …………………..

    EAR …………………..

    Lt


    SYSTEM EXAM

    CARDIO-VASCULAR

    B.P………………

    HEART…………….



    RESPIRATORY SYSTEM

    LUNGS……………

    CHEST X-RAY



    GASTRO INTESTINAL

    ABDONEN

    OTHERS


    HERNIA

    VARICOSE VEINS

    EXTREMITIES

    DEFORMITIES

    SKIN

    VENEREAL DISESES

    CLINICAL

    C N S

    PSYCHIATRY

    1. LABORATORY INVISTIGATONS

    TYPE OF LAB INVISTIGATONS

    RESULTS

    URINE

    SUGAR

    ALBUMIN

    BILHARZIASIS

    (IF ENDEMIC)

    STOOL

    ROUTINE

    1. HELMINTHES
    2. GIARDIA
    3. BILHARGIASIS (IF ENDAIC CULTURE)
    4. SALMONELLA

    SHEGELLA

    V CHOLERA (IF ENDEMIC)

    BLOOD

    HAEMOGLOBIN

    THICKFILM FOR

    1. MALARIA
    2. MICRO FILARIA

    SEROLOGY

    1. F B S
    2. SGOT, SGPT
    3. CREATINNE

    4. S - BILIRABIN

    ELISA

    1. HIV 1.2 TEST
    2. HBs Ag
    3. Anti HCV

    VDRL

    TPHA (IF VDRL POSITIVE)

    PREGNANCY TEST


    Notes about medical and laboratory investigation

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

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

    ………………………………………………………………………………………………………………………

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

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

    ………………………………………………………………………………………………………………………

    Dear, Sir,…………………………………………..

    Mentioned above is the medical report for Mr. / Mrs

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

    He / She is fit

    For the above mentioned job

    Unfit

    Chief Physician

    Stamp Name : …………………….

    Signature :

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

    (1) Stamp of the medical center on the photo and application

    (2) Chest : Free of pathological changes

    the medical report and x-ray should be submitted to the health authorities in GCC countries.

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