Adroit Consultancy Medicolegal Services

PREINSURANCE HEALTH CHECKUP MEDICAL EXAMINATION REPORT

PART - A : PRELIMINARY DATA : -

SR NO : 1 REPORT NO: ACM/01/2006 DATE : 13/11/2006

CLIENT NAME: Singh Shyam Narayan AGE: 51

PART - B : INSURANCE COMPANY DETAILS : -

NAME OF INSURANCE COMPANY : UNITED INDIA INSURANE CO LTD DIVISIONAL OFF :- DO- 04

PART - C : MEDICAL EXAMINATION : - ( Filled by the medical Examiner )

POSITIVE HISTORY : B.P.: - NO / DIABETES : NO / THYROID DISEASE: NO / ASTHMA: NO / HEART : NO

PART - D : GENERAL EXAMINATION : -

BODY WEIGHT : 84 Kgs HEIGHT : 168 Cms

PULSE : 78 / min BLOOD PRESSURE : 120/80 mmHg

RIGHT EYE : CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

LEFT EYE : CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

PART - E : SYSTEMIC EXAMINATION : -

RESPIRATORY SYSTEM No Abnormality

CARDIOVASCULAR SYSTEM No Abnormality

PART- F: INVESTIGATIONS : -

BLOOD-HB : 15.6 gm % gm% BLOOD - TC : 8700 / cumm

DC-N/L/M/B : N: 68 / L:16 / M: 14 / B: 0 / E : 2

GLYCOSYLATED HB : 6.1 (NORMAL RANGE : 5.0 to 8.0) (Normal Range :)

SERUM CHOLESTEROL : 175mg% (NORMAL RANGE: 152 to (Normal

60) Range :)

X-RAY CHEST : NORMAL

ECG : NORMAL

USG : NORMAL

STRESS TEST : NORMAL

X-RAY BOTH KNEE : Osteoarthritis changes in both knees, Calcification posterior to femur.

PART-G EXCLUSION : -
1) Osteoarthritis of both knees.

2) Calcification posterior to femur.

With regards

(Dr M D Gupta)
MBBS, MD, DNB, PGDHA
Reg No.: 79197
(Adroit Consultancy Medicolegal Services)
SR NO : REPORT NO: DATE : CLIENT NAME: AGE:

1 ACM/01/2006 13/11/2006 Singh Shyam Narayan 51

1 ACM/01/2006 13/11/2006 Singh Shyam Narayan 51

2 ACM/01/2006 13/11/2006 Singh Shyam Narayan 51
3
4
5
6
7
8
9
10
11
12
13
14
15
 NAME OF INSURANCE COMPANY : DIVISIONAL OFFICE :

UNITED INDIA INSURANE CO LTD DO- 04

UNITED INDIA INSURANE CO LTD DO- 04

UNITED INDIA INSURANE CO LTD DO- 04
 POSITIVE HISTORY :

B.P.: - NO / DIABETES : NO / THYROID DISEASE: NO / ASTHMA: NO / HEART : NO

B.P.: NO / DIABETES : NO / THYROID DISEASE: NO / ASTHMA : NO / HEART : NO

B.P.: - NO / DIABETES : NO / THYROID DISEASE: NO / ASTHMA: NO / HEART : NO
BODY WEIGHT : HEIGHT : PULSE : BLOOD PRESSURE :

84 168 78 120/80

84 168 78 120/80
84 168 78 120/80
 RIGHT EYE :

CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES
 LEFT EYE :

CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES

CATARACT : NO / GLAUCOMA : NO / REFRACTIVE ERROR : YES
 RESPIRATORY SYSTEM CARDIOVASCULAR SYSTEM

No Abnormality No Abnormality

No Abnormality No Abnormality
No Abnormality No Abnormality
 BLOOD-HB : BLOOD - TC : DC-N/L/M/B :

15.6 gm % 8700 / cumm N: 68 / L:16 / M: 14 / B: 0 / E : 2

15.6 gm % 8700 / cumm N: 68 / L:16 / M: 14 / B: 0 / E : 2

15.6 gm % 8700 / cumm N: 68 / L:16 / M: 14 / B: 0 / E : 2
 GLYCOSYLATED HB : SERUM CHOLESTEROL :

6.1 (NORMAL RANGE : 5.0 to 8.0) 175mg% (NORMAL RANGE: 152 to 60)

6.1 (NORMAL RANGE : 5.0 to 8.0) 175mg% (NORMAL RANGE: 152 to 60)
6.1 (NORMAL RANGE : 5.0 to 8.0) 175mg% (NORMAL RANGE: 152 to 60)
 X-RAY CHEST : ECG :

NORMAL NORMAL

NORMAL NORMAL
NORMAL NORMAL
 USG : STRESS TEST :

NORMAL NORMAL

NORMAL NORMAL
NORMAL NORMAL
 X-RAY BOTH KNEES :
1
Osteoarthritis changes in both knees, Calcification posterior to femur. 1) Osteoarthritis of both knees.

Osteoarthritis changes in both knees, Calcification posterior to femur. 1) Osteoarthritis of both knees.
Osteoarthritis changes in both knees, Calcification posterior to femur. 1) Osteoarthritis of both knees.
 PART G : EXCLUSION
2 3
2) Calcification posterior to femur.

2) Calcification posterior to femur.

2) Calcification posterior to femur.
PART G : EXCLUSION
4 5
6