NIPER Joint Entrance Examination (JEE) 2021- MASTER’S (Ahmedabad; Guwahati; Hajipur; Hyderabad; Kolkata; Raebareli; S.A.S.Nagar)
Annexure - 1 MEDICAL CERTIFICATE (To be submitted in original at the time of admission) 1. Name________________________________________________________________ 2. Father’s name_________________________________________________________ 3. Date of birth___________________________________________________________ 4. Identification Marks______________________________________________________ a) Height_______________ b) Weight_______________ c) Vision i) Night Blindness________________; ii) Colour Blindness________________ d) Report on any Physical Deformity________________________ LABORATORY EXAMINATION i. Routine Urine Test ___________________________________________________ ii.
Report on Hb, TC, DC, ESR of blood and blood group _______________________
iii.
Routine stool test ___________________________________________________
iv.
Report on latest PA view X-ray of chest___________________________________
v.
Report on blood pressure______________________________________________
vi.
Report on ECG______________________________________________________
vii.
History of chronic illness, if any__________________________________________
I certify that: i.
I have carefully examined Mr./Ms. ______________________________ in my presence.
ii.
He/She is not suffering from any mental or bodily disease/infirmity making him unfit for/likely to make him/her unfit for higher studies.
Signature of Medical Officer Full Name_____________________________ Registration No. _______________________ Designation___________________________ Name of the Hospital___________________ Date___________ Report should be signed by a Registered Medical Practitioner, of a Govt. hospital, not below the rank of Asstt. Civil Surgeon/Physician.
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