CERTIFICATE OF PHYSICAL FITNESS
PERSONAL DETAILS
Name
Gender
Date of Birth
Age (in years)
Blood Grouping
Identification Marks
History of Allergy if any
History of Medical illness if any
History of Hospitalization / previous Surgery if any
History of Current Medication for any illness
Vaccinate now for
Chicken Pox :
Hepatitis A:
Hepatitis B:
Typhoid :
TT :
Cholera :
Others if any:
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