Medical Examination
Clinical Examination

Height: cm
Weight: kg
BMI:
Build & Nutrition:
Blood Pressure: mmHg
Pulse: /m

General Inspection
A:
cy:
I:
Cl
e:

Chest:
Chest Inspiration: cm
Chest Expiration: cm
Skin:
Muscular Skeletal:
Blood Routine Examination

Haemoglobin
 %gm/dl
Total Leucocyte Count
 cu./mm
Differential Leucocyte Count
Neutrophils:
 %
Lymphocytes:
 %
Monocytes:
%
Eosinophil:
%
Basophilis:
 %

esr:
 %
FBS:
 mg/dl
rBS:
 mg/dl

renal function test
Uric Acid:
 mg/dl
Urea:
 mg/dl
Creatinine:
 mg/dl
EYE
Distant vision

(without glasses)
Near vision

(without glasses)
Distant vision

(with glasses)
Near vision

(with glasses)
color vision

as per ishihara's chart
LEFT EYE RIGHT EYE LEFT EYE RIGHT EYE LEFT EYE RIGHT EYE LEFT EYE RIGHT EYE
BOTH EYES
6/ 6/ N/ N/ 6/ 6/ N/ N/ > Normal />Defective
REMARKS:
DEFORMITIES CONGENITAL/ACQUIRED:

Refractive Power
Right eye
left eye
dsph
dcyl
axis
v
dsph
dcyl
axis
v
distance
Near(reading)