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Patient Visit
Health Surveillance
PERIODIC MEDICAL EXAMINATION CARD
Height(cms)
Weight(kgs)
PULSE
BMI
BP
mm of Hg
Vision
RT.EYE
LT.EYE
Findings of Chest Radiograph (done after every 03 year)
<?php echo $chest_radiograph ?>
Distant Vision
6/
6/
Near Vision
N/
N/
COLOR VISION
value="NORMAL" /> Normal
value="defective" />
DEFECTIVE
NORMAL
DEFECTIVE
ECG Findings:
RESULT OF SPIROMETRY Findings
Parameters
Performed Value
Predicted Value
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
Stool RE/ME
<?php echo $stool_re_me ?>
Urine RE/ME
Albumin
Sugar
Remarks/Opinion By Doctor
<?php echo $opinion_remarks?>
Digital Signature
Add
Remove