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Medical test regis t rati on confir mation thc.J1~
LlQl.sWI vu1=J''l3.1
GUlf Hulth (ouncll

Med ical test re gistr ation slip

Merchant Reference No Ap pointment­
11105202232224801-ju3xNgcg41
GCC Slip No 11105202232224801
First name MOHAM MAD RAFIK Nationality Indian
Last name Natio nal lD L1792593
Gender Male Marital status Unmarried
Country traveling to Oman Date of Birth 1991-01-20
Passport No L1792593 Passport Expiry Date 2023-04-10
Passport isrue place PATNA Pqsspo mue date 2013-04-11
Position Labour Payment Status PAID
Amount 10 U50

Me dica l ce nter info r mation

Medical center name AI Amal Oiagnostic Centre
Medical center address India, Mumba , Kanak ia Zillion.A - 1011102., 1st. Roor 8KC Annex. Junction of CST
Road. & lBS Marg. Kurla, Mumbai - ~

Medica! center phone number +91222652l.O87

Medical center e-mail qa ~ [email protected] III
Medical center website

W orking hours
Monday 10:00 -4:00PM
Tuesday 10:00 -~:oo PM

Wednesday 10:00 4:00 PM

Th ursday 10:00 A. - :00 PM
Friday 10:00 AM - 4:00 PM
Saturday aosed
Sunday Closed

Barcode
111I111 mlll lllllllllll~ ~IIIIIIIIIIII ~ 111111111111 11111 ~I
Generated date 11/May/2022 11 p S V<Jl d onlv II 'lQ/Ju '2022
Detailed candidate report Cb..c..II UJ1.4o
il91.JW1 ~ Jg.:ll
Medical center name Gulf Health Council
AI Amal Diagnostic Centre
G.H.C. Code No. GCC Slip No. Date examined Report expi ry date
01/03/06 11105202232224801 12/5/2022 13/8/2022

CANDIDATE INFORMATION

Name Gender Nationality Traveling to

MOHAMMAD RAFIK Male Indian Oman
Marital status Passport No. Age Passport expiry date Phone Profession
Unmarried L1792593 31 10/4/2023 +919920486956 Labour
Height Weight BMI
155.0 em 61.0 kg 25.39

MEDICAL EXAMINATION: GENERAL INVESTIGATION

Blood pressure 120/80 Pulse/min 84 Chest X-Ray NAD Comment
RRimin 18
LABORATORY INVESTIGATION
VISUAL ACUITY AIDED AND UNAIDED
Colour vision Normal Comments BLOOD
DISTANT/AIDED Blood group B- Haemoglobin g/dL 15.4
Left eye 6/ Right eye 6/ THICK FILM FOR
DISTANT/UNAIDED Malaria Absent Micro filaria Absent
Left eye 6/ 6 Right eye 6/ 6 BIOCHEMISTRY
NEAR/AIDED R.B.5 114.0 L.F.T Normal
Left eye 20/ Right eye 20/ Creatinine 1.1

NEAR/UNAIDED SEROLOGY
Left eye 20/ 20 Right eye 20/ 20 HIVI&II Negative HBsAg Negative
Anti Hev Negative VORL Negative
HEARING TPHA (if VORL Negative
Left ear Normal Right ear Normal positive)

URINE
SYSTEM EX AM IN ATI ON gar Negative Negative
Gener al NAD Cardfovasc u a r AD
appearance STOOL
Respiratory NAD ENT NAD
ROUTINE
GASTRO INTEST 'I NAL
Helminthes Absent OVA Absent
Abdomen (Mass, NAD Hernia NAD
CYST Absent Others
tenderness)

GENITOURINARY VACCINATION STATUS

Genitourinary NAD H ydrocele NAD Polio No Date
MUSCULOSKELETAL MMRl Yes Date 12105/2022
MMR2 Yes Date 12/05/2022
Extremities NAD Back NAD
Meningococcal No Date
Skin NAD C.N.S. NAD
COVID-19 Yes Date 22111/2021
Deformities NAD
Remarks
MENTAL STATUS EXA MINATION

APPEARANCE
Appearance NAD Speech NAD criteria
Behaviour NAD

COGNITION
DR. YOUSIF 1. QABAGEI
Doctor 's name Signatur
Cognition NAD Ori tation NAD
Memory NAD oneentration NAD
Mood NAD Thoughts NAD
Others Remarks 111111111111111111111111111111111111111111 111 1111111111111111111111

PO Ri~"3d j Phone 966 4885270 Fax: 96614885266 1Email 10; [email protected]

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