MEDICAL DEPARTMENT

Name : Age/Sex : diff($to)->y; if ($gender == 'M') echo " Male"; elseif ($gender == 'F') echo " Female"; ?>		JOB TITLE:
Father's Name :
Mobile No. :	Department : Contractor:	WAH No-
Gate Pass NO./P No. :	Screening Date :

0) { $rowl = @mysqli_fetch_array($resultl); $param_present = (explode(',', $rowl['question_id'])); } do { $count = 0; ?>

कृपया नीचे दिये गए प्रश्न के उत्तर हाँ या ना मे दीजिये
क्रमांक	लाक्षणिक प्रश्न	हां/नहीं	Sr.No	Symptomatic Questions	Yes/No	क्रमांक/Sr.No	लाक्षणिक प्रश्न/Symptomatic Questions	हां/नहीं/Yes/No
	/	0) { foreach ($param_present as $x => $val) { if ($val == $row['question_id']) { echo 'Yes'; $count = 1; } } if ($count == 0) { echo 'No'; } } ?>
Certified that the particulars given by me in the foregoing above are true, complete and correct to the best of my knowledge and belief. If any of this information is found to be false/incomplete/ incorrect I shall be responsible for it. मैं अपने पूरे होशोहवाश में यह प्रामाणिक करता हूँ की मेरे द्वारा दी गयी उपरोक्त समस्त जानकारी पूर्णत: सही है, अगर मेरे द्वारा दी गयी कोई जानकारी गलत पाई जाती है तो उसके लिए पूर्णत: मैं जिम्मेदार हूँ एवं कंपनी को यह अिधकार है की वो मुझे नौकरी में ना रखे अथवा मेरी सेवाओं को ससमाप्त कर दे | Signature/left thumb impression

INITIAL MEDICAL EXAMINATION FOR WORK AT HEIGHT
GENERAL HEALTH CHECK-UP
Height		Weight		BMI
BP		Mmhg		PULSE		Min
History of Addiction
Alcohol		Smoking		Tobacco
Chronic Disease	DM/ HTN/ Asthma/ Epilepsy
RBS			Mg/dl
Ptosis			Diplopia
Nystagmus
Tandem walking
Romberg’s sign
Co-ordination test
ENT Exam.
Vertigo			Tinnitus
History of WAH:
BP (After Height Bar Test)		/ mmHg	Pulse (After Height Bar Test)			/Min
Medical Test:		Height bar Test:
		Ref No:		Sign of safety Person:
Overall Remarks:	Fit / Unfit	Sign of MO :