| DLME Examination Report | |
| (For Interval: ) |
| Sr N. | Screening Date | Name | Employer | ECode/G.Pass | Gender | Age | Blood group | Designation | Devision | Department | Ute | Section | Mobile No. | Identification Marks | Height | weight | BMI | Blood Pressure | Pulse | Dis.Vision Rt Eye | Dis.Vision Lt Eye | Near Vision Rt Eye | Near Vision Lt Eye | Color Vision | Fitness Status |
| TOTAL: | |||||||||||||||||||||||||