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MEDICAL EXAMINATION REPORT
Medical History
Physical Examination
Control Number
The applicant has been assessed to be having the following condition/s.
1. Nose or Throat Trouble
2. Ear trouble or deafness
3. Asthma
4. Tuberculosis
5. Other lung disease
6. High blood pressure
7. Heart trouble
8. Rheumatic fever
9. Diabetes Mellitus
10. Endocrine disorders
11. Cancer or tumor
12. Mental disorders
13. Head or neck injury
14. Hernia (ruptured)
15. Joint/back problems
16. Typhoid or parathyroid fever
17. Trachoma or other eye trouble
18. Stomach pain or ulcer
19. Other abdominal trouble
20. Kidney or bladder trouble
21. Sexually transmitted disease
22. Genetic or familial disorders
23. Malaria
24. Operations
25. Tropical diseases
26. Chronic cough
27. Fainting spells
28. Frequent headaches
29. Dizziness
COVID-19 Vaccination
1st Dose / Janssen
2nd Dose / Janssen
1st Booster
2nd Booster
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Weight
Pulse Rate
Speech
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Height
Resp. Rate
Systolic BP
Diastolic BP
Speech
Hearing (Left)
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Hearing (Right)
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Color vision
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Far Vision (Left) Uncorrected
20/
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Far Vision (Left) Corrected
20/
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Far Vision (Right) Uncorrected
20/
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Far Vision (Right) Corrected
20/
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Near Vision (Left) Uncorrected
J
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Near Vision (Left) Corrected
J
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Near Vision (Right) Uncorrect..
J
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Near Vision (Right) Corrected
J
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Systems
Skin
Normal
Abnormal
Head, Scalp
Normal
Abnormal
External Eye
Normal
Abnormal
Ophtha exam
Normal
Abnormal
Ears
Normal
Abnormal
Nose, Sinuses
Normal
Abnormal
Mouth, Throat
Normal
Abnormal
Neck, Nodes, Thyroid
Normal
Abnormal
Chest, Breast, Axilla
Normal
Abnormal
Waived
Lungs
Normal
Abnormal
Heart
Normal
Abnormal
Abdomen
Normal
Abnormal
Back
Normal
Abnormal
Anus - Rectum
Normal
Abnormal
Waived
G-U System
Normal
Abnormal
Waived
Inguinals, Genitals
Normal
Abnormal
Waived
Reflexes
Normal
Abnormal
Extremities
Normal
Abnormal
Dental
Normal
Abnormal
Diagnostics
Complete Blood Count
Normal
Abnormal
Not Required
HIV Test
Non-Reactive
Positive
Not Required
Urinalysis
Normal
Abnormal
Not Required
Drug Test
Negative
Positive
Not Required
Fecalysis
Normal
Abnormal
Not Required
Hepa B Screening
Non-reactive
Positive
Not Required
Chest X-Ray
Normal
Abnormal
Not Required
Blood Type
Other Tests
12-L ECG
Normal
Abnormal
Not Required
Spirometry
Normal
Abnormal
Not Required
Psychological Test
Normal
Abnormal
Not Required
Submit
MER has been recorded
