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  • Certificate of Physical Fitness: Personal Details

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    Vijay Kumar
    41 views2 pages
    This document is a certificate of physical fitness that contains personal and medical details of an individual. It includes their name, gender, date of birth, age, blood grouping, identification marks, history of allergies, illnesses, hospitalizations, current medications, and vaccinations. It also contains measurements of their pulse, blood pressure, height, weight, and BMI. The physical examination section notes the individual's build, any bodily infirmities, communicable diseases, and examination of key body systems. The doctor certifies that except as noted, they found no disease or issues. They also confirm the individual has been vaccinated against several diseases.

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    Original Title

    PhysicalFitness Certificate

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    This document is a certificate of physical fitness that contains personal and medical details of an individual. It includes their name, gender, date of birth, age, blood grouping, identification marks, history of allergies, illnesses, hospitalizations, current medications, and vaccinations. It also contains measurements of their pulse, blood pressure, height, weight, and BMI. The physical examination section notes the individual's build, any bodily infirmities, communicable diseases, and examination of key body systems. The doctor certifies that except as noted, they found no disease or issues. They also confirm the individual has been vaccinated against several diseases.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    41 views2 pages

    Certificate of Physical Fitness: Personal Details

    Uploaded by

    Vijay Kumar
    This document is a certificate of physical fitness that contains personal and medical details of an individual. It includes their name, gender, date of birth, age, blood grouping, identification marks, history of allergies, illnesses, hospitalizations, current medications, and vaccinations. It also contains measurements of their pulse, blood pressure, height, weight, and BMI. The physical examination section notes the individual's build, any bodily infirmities, communicable diseases, and examination of key body systems. The doctor certifies that except as noted, they found no disease or issues. They also confirm the individual has been vaccinated against several diseases.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    CERTIFICATEOFPHYSICALFITNESS

    PERSONALDETAILS

    Name

    Gender

    DateofBirth Age(inyears)

    BloodGrouping

    IdentificationMarks

    HistoryofAllergyifany

    HistoryofMedicalillnessifany

    HistoryofHospitalization/previousSurgeryifany

    HistoryofCurrentMedicationforanyillness

    Vaccinatenowfor ChickenPox:

    HepatitisA:

    HepatitisB:

    Typhoid:

    TT:

    Cholera:

    Othersifany:

    Page1
    CERTIFICATEOFPHYSICALFITNESS

    NAMEOFTHECANDIDATE:

    Pulse /Min Height Cms


    BP Mm/Hg Weight Kgs
    BodilyInfirmity BMI
    CommunicableDisease Build
    Pallor Icterus Clubbing Cyanosis Lymphadenopathy Oedema
    Tonsils Glands Teeth
    CVS HeartSounds Murmurs
    RS BreathSounds AddedSounds
    GIS Liver Spleen Any
    Mass
    CNS CranialNerves MotorSystem Sensory
    System
    G.U.S(Male) Hydrocele Piles Phymosis
    G.U.S.(Female) MenstrualHistory
    Skin
    Hearing Vision(NV/DV) ColourVision
    Normal/Corrected(Power)
    OtherFindings/remarks
    ifany.

    ________________________ ______________________
    (Signatureofthecandidate) (SignatureoftheParent)

    I do hereby certify that I / We have examined Mr. / Ms. _____________________________________________, a


    candidateforstudentunderVITUniversity,_____________Campusandwhosesignatureisgivenabove,andcannot
    discoverthathe/shehasanydisease,communicable,otherwiseorconstitutionalaffectionorbodilyinfirmityexcept
    thathis/herweightisinexcessof/belowthestandardprescribedorexcept____________________________

    Ialsocertifythathe/shehasbeenvaccinatedandhadboosteragainstHepatitisA,B,TT,Typhoid,Chickenpox&
    Measles

    NameoftheDoctor :
    Photographof
    SignatureoftheDoctor : thecandidateto

    beaffixedand
    Designation :
    attestedbythe
    Date&Place : Doctor

    SealwithReg.No. :

    Page2

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