Height(cms)

Waist(cms)

CLINICAL EXAMINATION

Weight(kgs)

Hip(cms)

NAILS Pink Pale Clubbing

BMI(cms)

PULSE

Vision

BP mm of Hg

RT.EYELT.EYE

ABDOMEN

Liver

Speen

Tenderness

Any other abnormality

Distant Vision Without Glasses

6/6/

With Glasses

6/6/

Near Vision Without Glasses

N/N/

With Glasses

N/N/

RS

Any other eye disease

Skin

IDENTIFICATION OF INDIVIDUAL COLOURS value="NORMAL" /> Normal value="DEFECTIVE" /> DEFECTIVE Normal DEFECTIVE

MUSCULO SKELETAL

COLOR VISION value="NORMAL" /> Normal value="DEFECTIVE" /> DEFECTIVE Normal DEFECTIVE

ANY OTHER RELEVANT FINDING

CVSS1 S2

Any other Sound ECG (12 Lead) findings

ENT

Conversational Hearing

Auroscopy

EAR

Nose

Throat

CNSSpeech Higher Function Motor Function Vertigo Reflexes(superficial & deep) Vibration Syndrome		GENITO-URINARY Hernia Hydrocele Phimosis Piles Fistula
ILO CLASSIFICATION OF CHEST RADIOGRAPH (Enclosed Chest Radiograph)
Profusion of Pneumoconiotic opacities	Grades	Types
value="PRESENT"/> PRESENT value="ABSENT"/> ABSENT PRESENT ABSENT

RESULT OF SPIROMETRY Findings
Parameters	Performed Value	Predicted Value	% of Predicted
Forced Vital Capacity (FVC)
Forced Expiratory Volume in 1 sec (FEV1)
FEV1/FVC
Peak Expiratory Flow

RESULT OF AUDIOMETRY FINDINGS
Conduction Type	Left Ear	Right Ear
Air Conduction	/> Normal /> ABNORMAL	NORMAL ABNORMAL	/> NORMAL /> ABNORMAL	NORMAL ABNORMAL
Bone Conduction	/> Normal /> ABNORMAL	NORMAL ABNORMAL	/> Normal /> ABNORMAL	NORMAL ABNORMAL
INVESTIGATIONS
Blood Group
Hb	TLC DLC-N DLC-L DLC-M DLC-E	VDRL
S. Urea	S.Creatinine Blood Sugar	ESR
HbsAg	HIV Lipid Profile
Urine RE/ME
Appearance	Pus cells RBCs	Epithelial cells
Albumin	Other Relevant findings	Sugar
Stool RE/ME<?php echo $stool_re_me?>
Opinion/ Remarks (By Medical Assistant)	<?php echo $opinion_remarks_medical_assistant?>
Signature Of Medical Assistant Add Remove