RECORD OF MEDICAL EXAMINATION

Height(cms) Waist(cms) CLINICAL EXAMINATION
Weight(kgs) Hip(cms) NAILS   Pink     Pale     Clubbing
BMI(cms) PULSE
Vision BP  mm of Hg
RT.EYELT.EYE ABDOMEN
Distant Vision Without Glasses
With Glasses
Near Vision Without Glasses
With Glasses SKIN
Any other eye disease RS
MUSCULO SKELETAL
IDENTIFICATION OF INDIVIDUAL COLOURS
  Normal   DEFECTIVE ANY OTHER
NYSTAGMUS GENITO - URINARY CNS
COLOR VISION   Normal     DEFECTIVE  
Signature of Medical Assistant
ENT CVS
14. ILO CLASSIFICATION OF CHEST RADIOGRAPH (Enclosed Chest Radiograph)
Profusion of Pneumoconiotic opacities Grades Types
  Present     Absent  
15. RESULT OF SPIROMETRY (Report Enclosed)
Parameters Predicted Value Performed Value % of Predicted
Forced Vital Capacity (FVC)
Forced Expiratory Volume in 1 sec (FEV1)
FEV1/FVC
Peak Expiratory Flow