Get Form No. Nb/59

Filling out Form No. NB/59 is an essential step in the evaluation process regarding deformities and impairments. This guide provides a clear and systematic approach to completing the form online, ensuring that all necessary information is accurately captured.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the proponent or life assured in the designated field at the top of the form.
3. Proceed to answer the questions regarding the cause of the deformity. Indicate whether it is congenital, due to an accident or injury, or due to any underlying disease.
4. Provide information about the duration of the deformity, filling in the date when it was first present.
5. If the deformity is due to an underlying disease, specify the disease, the date it occurred, and whether it is stationary or progressive.
6. Indicate if the individual has control over bowel and bladder movements.
7. Detail the exact parts of the body affected, the functions impacted, and any restrictions observed in movements.
8. Note if there is a limp and if the person can walk and run without assistance.
9. Provide details on the ability to squat, sit, and stand, as well as if the affected limb is shorter than the other, including the extent in centimeters.
10. If applicable, provide details regarding muscle wasting due to poliomyelitis.
11. Describe any respiratory complications or restrictions in finger movement. Include information about any fingers that may have been removed.
12. Indicate if the individual can lift and hold items without difficulty. Assess the grip strength.
13. Conclude with a statement regarding any residual complications and the capacity for routine self-care activities.
14. Submit any supporting documents, such as previous treatment details and special reports, as needed.
15. Finally, sign the form alongside the medical examiner or medical attendant, including their qualifications and registration number.
16. Once all fields are completed, you can save changes, download, print, or share the form as required.

Complete your documents online with ease and ensure all information is thoroughly reviewed.