Medical Health

REASSESSMENT FORM

Date of CXR:

CHEST X-RAY (Mention positive findings along with the grading)

MEDICAL HISTORY –

Please indicate if you have any pre-existing medical condition -

Please indicate if any new medical condition that may have arisen since your last IME-

CLIENT’S FINDINGS

Height (cm) and Weight (kg)

BP (Systolic / Diastolic)

Serum Creatinine (if required for HPT or DM)

Additional Medical Investigations for with client’s with new findings or health condition

Other investigation (s):

COMMENTS:

PP NAME: PP’s STAMP:

Contact this candidate