SRMS SECONDARY SCHOOL

Medical Examination Form

To be completed by a Doctor/Medical Officer at a Government Hospital or Health Centre

This form should be completed, signed and officially stamped by the examining medical professional before the student reports to school.

Student Name: ____________________________________________________________ Age: ______ Sex: ______

1. Vision

2. Hearing

3. Chest & Lungs

4. Heart

5. Urine Analysis

6. Blood Test / HB / Sickle Cell

7. Chronic / Communicable Illnesses

DOCTOR'S REMARKS

MEDICAL FITNESS:
The student is: [ ] FIT [ ] UNFIT to join secondary school studies.

Doctor / Medical Officer Name

Signature

Date

Official Hospital / Health Centre Stamp

OFFICIAL STAMP