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SECTION B
(TO BE COMPLETED BY A REGISTERED MEDICAL OFFICER OR DOCTOR)
IV. VARIOUS TESTS
(I) GENERAL APPEARANCE
(II) CARDIO-RESPIRATORY SYSTEM
Height _____________Weight _____________
(CHEST X-RAY FILM & REPORT ARE NEEDED)
Lung Fields __________Breast Lumps __________
Blood Pressure _______ Pulse Rate ________
Heart Size __________ Heart Sounds __________
Lymphnode Palpable ____________________
Skin Appearance ______ _________________
(III) ABDOMINAL EXAMINATION
Throat Tonsils __________________________
(ABDOMINAL U.S.S. REPORT IS NEEDED. IF MASS
DETECTED
Teeth Dentition _________ Carious _________
FILM IS NEEDED)
EARS:
Contour: Sunken / Normal / Distended
Rt Hearing _______ Drum Membrane _______
Skin Scar ________________________
Lt Hearing _______ Drum Membrane ________
Umbilicus _____________ Hernia ______________
EYES:
(IV) MUSCULO SKELETAL SYSTEM
Rt VA __________ Squint __________
Any
Deformation? Yes / No
Lt VA ___________ Squint __________
If yes which part of the body __________________
Type of deformity ___________________________
V. LABORATORY INVESTIGATIONS
(III) HEMATOLOGY
(I) BIOCHEMICAL
Fasting Blood Sugar ______________________ (CULTA COUNTER)
Haemoglobin _________ ____________________
Serum Creatinine ______________________
White Cells Count __________________________
Serum Aspartate T. ______________________
Serum Alanine T. _______________________ (IV) PARASITOLOGY
Blood Urea
_______________________ Stool Routine Examination ___________________
Uric Acid
_______________________ Treatment_________________________________
Urinalysis & Sediment Microscopy
(II) IMMUNOLOGY
VDRL Reaction if +ve treatment______________ ______________
Widal Reaction if +ve treatment______________ Treatment ________________________________
Contact with Human Immunodeficiency Virus
Blood Smear for Protozoa, Hemoflagellates &
Sero conversion (Optional) _________________ Spirochaetae ______________________________
Treatment ________________________________
VI. OTHER OBSERVATIONS
Any other observations whether irritable or aggressive:
VII. DECLARATION