GENERAL HEALTH CHECK-UP
Height

(in CMS)
Weight

(in KGS)
BMI
BP

(in mmhg)
Pulse

(per min)

History of Addiction
Alcohol
Smoking
Tobacco


Chronic Disease
Ptosis
Diplopia
Nystagmus


RBS
Tandem walking
Romberg’s sign


ENT Exam.
Vertigo
Tinnitus
History of WAH:


Co-ordination test
Remarks


Medical Test:
Height bar Test:
Ref No:
BP

(After Height Bar Test)
Pulse

(After Height Bar Test)