Medical Examination Report
Patient Details
Name
Mr. Janka Perera
Age
39 Years
Address
39 Years
NIC Number
39 Years
Company
39 Years
PO Number
39 Years
Employee Number
39 Years
01. General Examination
Phisique
39 Years
Mentality
39 Years
02. Oral Hygene
39 Years
03. Ears, Nose & Throat (ENT)
Ears
39 Years
Nose
39 Years
Throat
39 Years
04. Eyes
Right Eye
Distant Vision
39 Years
Near Vision
39 Years
Left Eye
Distant Vision
39 Years
Near Vision
39 Years
Color Vision
39 Years
05. Cardio Vascular system
Pulse Rate
39 Years
Rhythm
39 Years
BP
39 Years
HT Sound
39 Years
06. Respiratory system
Lungs
39 Years
Added Sound
39 Years
07. Abdomen
Liver
39 Years
Any Lumps
39 Years
Hernia
39 Years
Spleen
39 Years
Scars
39 Years
Haemorrhoids
39 Years
08. Genito Urinary system
Genitalia
39 Years
09. Skin
Rashes
39 Years
Warts
39 Years
10. Central Nervous system
Reflexes
39 Years
Carnial Nerves
39 Years
11. Females
LRMP
39 Years
Menstrual History
39 Years
12. Medical History
39 Years
13. Investigation
14. Foot Care
Toes
39 Years
Toe Nails
39 Years
Skin Rashes
39 Years
15. Referrals
39 Years
16. Substances(Drugs & Liquor)
Smoking
39 Years
Drinking
39 Years
Betel
39 Years
Babul
39 Years
Areca
39 Years
15. Illnesses within Past 7 Days
Fever
39 Years
Cold
39 Years
Dengue
39 Years
Covid
39 Years
Influenza
39 Years
Currently undergoing treatment for an illness?
This is to confirm you that was medically Examined by me and certify that is Physical and Mental health to work in a Company
Date
39 Years
Medical Officer
Dr. (Brig) S.D.C. De Silva RWP RSP
MBBS(Cey) DLO(SL)
ENT SURGEON
Reg. No. 8426