Health Certificate

Name in Full : Amit Rayamajhi Sex : Address : Gorkha-05, Gorkha, Nepal Nationality : Nepali

Male

Date of Birth : Date of Exam :

5-Mar-1990 23-12-2012

Height : Weight : Colour Vision : Normal Blood Pressure 115/65 mmHg

PHYSICAL REPORT 173cm 63 Kg

Visoion Hearing

R L R Normal L Normal

6/6 6/6

Urinalysis

Urine Protein Urine Glucose Urobilinogen Urine Blood

LABORATORY REPORT Nil Nil Nil Nil Negative

Tuberculin Reaction Blood Group : B Rh: Positive

Chest X-ray

Lung fields clear Cardiac Size Normal Costophrenic angle Clear

Impression

Normal Findings

SUMMARY AND RECOMMENDATION Physically and mentally fit, no communicable disease at present

HOSPITAL STAMP

DOCTOR'S SIGNATURE