OHC Mob.
MO Mob:
Email:
MEDICAL DEPARTMENT
FOOD HANDLER EXAMINATION

Form No. : Date:
Name:......................... Age:    diff($to)->y;?> Sex:
Father's Name:.................. Blood Group............
EmpID:.................. Designation:....................
Company/ Contractor Name:..................
Emai ID:    MOBILE NO:   
PERMANENT ADDRESS:    ,,,,,,

MEDICAL REPORT

(To be filled by the M.O.)

0) { $rowl = @mysqli_fetch_array($resultl); $param_present = (explode(', ', $rowl[0])); } $flag = 0; if (mysqli_num_rows($resultl) > 0) { foreach ($param_present as $x => $val) { if ($val == $illness_id) { echo '√'; $flag ++; break; } } } else { echo ''; } if ($flag == 0) { echo 'X'; } } ?>

Past and Present Ailment:

Asthma:    Diabetes Mellitus:    TB:   
Hypertension:    Jaundice:    Epilepsy:   
Psychiatric Illness:    Hernia/Hydrocele:    Heart Disease:   
Piles/Fistula:    Night Blindness:    Typhoid:   
Major Injury/Fracture/Operation:    Spondylosis:    Leprosy:   
Thyroid:    Vertigo:    STD:   
Any other disease:   

CLINICAL OBSERVATIONS/FINDINGS:

A CY I CL OE


Height cms Weight kgs BMI ...
Built & Nutrition...... BP:.....mm hg Pulse:......./m
P/A...... Skin...... Chest:......
Chest Inspiration:...... Chest Expiration:...... CVS:......
CNS:...... Musculo Skeletal: P/Abd:   
Dress:    Nail:    Hair:   
Other Diseases if any:    
Treatment and Advice:    
Remarks
This is to certify that Mr/ Ms has been examined and he / she is found to be medically for duty.


Signature: Date: Date:
Factory Medical Officer
Form No:TML/F/MED/01
Rev: 03