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Get IN Form 10-IA

FORM NO. 10-IA See sub-rule 2 of rule 11A Certificate of the medical authority for certifying person with disability severe disability autism cerebral palsy and multiple disabilities for purposes of section 80DD and section 80U Date 1. This is to certify that Shri/Smt. /Ms son/daughter of Shri age years male/female residing at Registration No* is a person with disability/severe disability suffering from autism/cerebral palsy/multiple disability. 2. This condition is progressive/non-progressive/likely to improve/not likely to improve. 3. Reassessment is recommended/not recommended after a period of months/years. Neurologist/Pediatric Neurologist/Civil Surgeon/ Chief Medical Officer Name Address of Institution/Government hospital Qualification/designation of specialist SEAL Signature/Thumb impression of the patient Note Strike out whichever is not applicable. This is to certify that Shri/Smt. /Ms son/daughter of Shri age years male/female residing at Registration No* is a person with disability/severe disability suffering from autism/cerebral palsy/multiple disability. 2. This condition is progressive/non-progressive/likely to improve/not likely to improve. 3. Reassessment is recommended/not recommended after a period of months/years. 2. This condition is progressive/non-progressive/likely to improve/not likely to improve. 3. Reassessment is recommended/not recommended after a period of months/years. Neurologist/Pediatric Neurologist/Civil Surgeon/ Chief Medical Officer Name Address of Institution/Government hospital Qualification/designation of specialist SEAL Signature/Thumb impression of the patient Note Strike out whichever is not applicable. This is to certify that Shri/Smt. /Ms son/daughter of Shri age years male/female residing at Registration No* is a person with disability/severe disability suffering from autism/cerebral palsy/multiple disability. 2. This condition is progressive/non-progressive/likely to improve/not likely to improve. 3. Reassessment is recommended/not recommended after a period of months/years. Neurologist/Pediatric Neurologist/Civil Surgeon/ Chief Medical Officer Name Address of Institution/Government hospital Qualification/designation of specialist SEAL Signature/Thumb impression of the patient Note Strike out whichever is not applicable. .

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