IBN Sina Medical Check-up Unit  
( GCC Approved Medical Check-up Center )
GCC Computer Code: 05/01/11

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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 post 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 …………………..

                                        Lt

 


SYSTEM EXAM

       CARDIO-VASCULAR

       B.P………………

       HEART…………….

 


RESPIRATORY SYSTEM

      LUNGS……………

      CHEST X-RAY

 


GASTRO INTESTINAL

          ABDONEN

  OTHERS

 

HERNIA

 

VARICOSE VEINS

 

EXTRENITIES

 

DEFORMITIES

 

SKIN

 

VENEREAL DISESES

          CLINICAL

 

C N S

 

PSYCHIATRY

 

 

 

1. ABORATORY INVISTIGATONS

 

TYPE OF AB INVISTIGATONS

RESULTS

 

URINE

             SUGAR                          

             ALBUMIN

             BILHARZIASIS

            (IF ENDEMIC)

 

 

 

STOOL

            ROUTINE

1.        HELMINTHES

2.        GUARDIA

3.        BILHZIASIS (IF ENDAIC CULTURE)

4.        SALMONELLA

       SHEGLLLA

                V CHOLERA (IF ENDEMIC)

 

 

 

BLOOD

               HAEMOGLORIS

               THICNFILM FOR

1.        MALARIA

2.        MICRO FILARIA

 

SEROLOGY

1.        F B S

2.        L E T S

3.        CREATINNE

 

EMSA

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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