Get Physical Fitness Certificate

CERTIFICATE OF PHYSICAL FITNESS PERSONAL DETAILS Name Gender Date of Birth Age in years Blood Grouping Identification Marks History of Allergy if any History of Medical illness if any History of Hospitalization / previous Surgery if any History of Current Medication for any illness Vaccinate now for Chicken Pox Hepatitis A Typhoid TT Cholera Others if any Page 1 NAME OF THE CANDIDATE Pulse /Min Height Cms BP Mm/ Hg Kgs Bodily Infirmity BMI Communicable Disease Build Pallor Icterus Clubbing Cyanosis Lymphadenopathy Tonsils Glands Teeth C V S Heart Sounds Murmurs R S Breath Sounds Added Sounds G I S Liver Spleen Any Mass C N S Cranial Nerves Motor System Sensory System G.U. S Male Hydrocele Piles Phymosis G.U.S. Female Menstrual History Skin Hearing Vision NV/DV Oedema Colour Vision Normal / Corrected Power Other Findings / remarks if any. Signature of the candidate I do hereby certify that I / We have examined Mr. / Ms. a candidate for student under VIT University Campus and whose signature is given above and cannot discover that he / she has any disease communicable otherwise or constitutional affection or bodily infirmity except that his / her weight is in excess of / below the standard prescribed or except I also certify that he / she has been vaccinated and had booster against Hepatitis A B TT Typhoid Chicken pox Measles Name of the Doctor Designation Seal with Reg.No. Photograph of the candidate to be affixed and attested by the Doctor Date Place Page 2. CERTIFICATE OF PHYSICAL FITNESS PERSONAL DETAILS Name Gender Date of Birth Age in years Blood Grouping Identification Marks History of Allergy if any History of Medical illness if any History of Hospitalization / previous Surgery if any History of Current Medication for any illness Vaccinate now for Chicken Pox Hepatitis A Typhoid TT Cholera Others if any Page 1 NAME OF THE CANDIDATE Pulse /Min Height Cms BP Mm/ Hg Kgs Bodily Infirmity BMI Communicable Disease Build Pallor Icterus Clubbing Cyanosis Lymphadenopathy Tonsils Glands Teeth C V S Heart Sounds Murmurs R S Breath Sounds Added Sounds G I S Liver Spleen Any Mass C N S Cranial Nerves Motor System Sensory System G*U. S Male Hydrocele Piles Phymosis G*U*S* Female Menstrual History Skin Hearing Vision NV/DV Oedema Colour Vision Normal / Corrected Power Other Findings / remarks if any. Signature of the candidate I do hereby certify that I / We have examined Mr. / Ms. a candidate for student under VIT University Campus and whose signature is given above and cannot discover that he / she has any disease communicable otherwise or constitutional affection or bodily infirmity except that his / her weight is in excess of / below the standard prescribed or except I also certify that he / she has been vaccinated and had booster against Hepatitis A B TT Typhoid Chicken pox Measles Name of the Doctor Designation Seal with Reg*No* Photograph of the candidate to be affixed and attested by the Doctor Date Place Page 2. CERTIFICATE OF PHYSICAL FITNESS PERSONAL DETAILS Name Gender Date of Birth Age in years Blood Grouping Identification Marks History of Allergy if any History of Medical illness if any History of Hospitalization / previous Surgery if any History of Current Medication for any illness Vaccinate now for Chicken Pox Hepatitis A Typhoid TT Cholera Others if any Page 1 NAME OF THE CANDIDATE Pulse /Min Height Cms BP Mm/ Hg Kgs Bodily Infirmity BMI Communicable Disease Build Pallor Icterus Clubbing Cyanosis Lymphadenopathy Tonsils Glands Teeth C V S Heart Sounds Murmurs R S Breath Sounds Added Sounds G I S Liver Spleen Any Mass C N S Cranial Nerves Motor System Sensory System G*U. S Male Hydrocele Piles Phymosis G*U*S* Female Menstrual History Skin Hearing Vision NV/DV Oedema Colour Vision Normal / Corrected Power Other Findings / remarks if any.