Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date at the top of the form. Next, fill in your name and age in the respective fields.
3. Provide a brief clinical history, if applicable, in the designated space.
4. In section A, start with the examination details. For physical examination, indicate any relevant findings.
5. Proceed to the investigations section. Fill out the haemogram details including Hb%, TLC, and DLC, along with a peripheral smear if needed.
6. Enter blood sugar levels for fasting and postprandial readings. Next, specify your lipid profile results, including total cholesterol and various cholesterol fractions.
7. Complete the liver function test results, noting the levels for total bilirubin, SGOT, SGPT, and alkaline phosphatase.
8. Next, fill in the details for the kidney function test including urea, creatinine, uric acid, and electrolytes.
9. Continue with the cardiac profile by providing details of CPK, CK-MB, LDH, and SGOT.
10. Document findings from the urine analysis: routine and microscopic, including results for sugar and albumin.
11. If applicable, include results from additional investigations such as E.C.G., X-ray Chest, or Ultrasound Abdomen.
12. In section B, summarize the medical report, indicating haemoglobin, blood sugar, cholesterol levels, liver functioning, kidney status, and cardiac status as normal, low, or high.
13. In section C, provide a summary of the medical report. Include remarks based on the health check-up and overall health of the officer.
14. Lastly, ensure to date and sign the form as required, including the designation of the medical authority.
15. Once all sections are completed accurately, save the changes, download the form, or share it as needed.

Complete your Form IV Proforma For Health Check Up online today.