APPENDIX NINE (II) LETTER TO THE DOCTOR [Vide Rule 48.6]- SS CODE

 APPENDIX NINE (II)

LETTER TO THE DOCTOR

[Vide Rule 48.6]

 

School:

Date:

Dear Doctor,

            Address

            Please carry out the medical examination of the following pupil and send us your report in 4 days’ time.

 

Yours faithfully,

Headmaster.

 

____________________________________________ High school __________________________Examination Doctor ________________________________ Pupil’s name _____________________________Std ______________ Div ______________________ Age __________________________ Health Class ______________________________ Ht ________________ WT ___________________

 

1. Eyes finding (H.S.                                      ) remarks:

2. E.N.T. findings (H.S.                                  ) remarks:

3. Teeth finding (H.S.                                     ) remarks:

4. Surgical finding (H.S.                                 ) remarks:

5. Medical finding (H.S.                                 ) remarks:

6. Consultant’s signature:

7. Date:

8. Anything special may be written on the reverse, if need be: