MEDICAL AUTHORIZATION LETTER
Corporate Name :
GE-PEHC
Appointment Details
JAYAMKONDAN VELMURUGAN
Employee name
Provider Details
Provider name
Balaji Medical centre
Employee no
Old No. 18, New No. 4 Jagadeeswaran
Street,T- Nagar City:-----Select---State:----Select---- Pincode:600017 Mobile:0
Phone:24364652-044-24364
3239593
Ta code
10/01/2023
Appointment date
Address
9:00AM
Appointment time
Plan B less than 40
Test Package
Details
Medical Package Details
History Review (FORM B-1)
Clinical Examination by Medical practitioner (FORM B-2)
Medical Fitness certificate in prescribed form (FORM B-3)
Instructions
(Please relate the instruction as per your test package)
1.You are requested to be present at the medical center at the
designated date & time.
2.You will be required to present a copy of this email and any one
of your Photo ID proofs (Employee ID Card & any government ID
Proof copy)
3.Kindly ensure to maintain the fasting status (avoid consuming
Visual acuity
food and drinks) 10-12 hours before the appointment. After dinner
Colour vision
and till blood sample is given intake of only water is allowed.
Urine: Routine & Microscopic
4.Kindly be aware of the following while your tests are done:
A.For TMT test insist for Physician to be present from start to end
Blood Group, CBC, ESR
of your TMT test.
B.In case you find Physician is not available then please do not
Fasting Blood Sugar
undergo the TMT test.
Uric acid, Creatinine
C.If you have any cardiac medical history then please inform
Physician it.
Lipid Profile
D.Men will need to shave their chest till their naval. Women should
Bilirubin, AST, ALT
wear comfortable clothing
G6PD deficiency (Qualitative)
E.Female nurses are present during ECG, ultrasound and X-Ray for
female clients.
Audiometry
F.Hygiene is maintained while conducting medical tests.
F.It is advisable to wear comfortable clothes/Running Shoes. You
Chest X Ray
may be required to change into Clothes provided by the center
ECG
during the tests such as ECG,TMT, Ultrasound and X-Ray ((if it’s a
Spirometry (lung function tests)
part of your test package)
5.While blood is drawn
A.Second puncture if required should be done with your consent.
B.Needle should be opened in your presence and destroyed after
blood draw.
C.Blood sample should be labeled in your presence.
6.Please intimate AHPL in case you feel any of the above
protocols are not adhered by medical center.
7.You are requested to carry along the morning Urine and Stool
samples (if it’s a part of your test package) in a clean container.
You can collect the containers from the designated medical center
in advance or you may purchase the containers from pharmacy
shops.
8.You are requested to be off contact lenses for 48 hours before
coming for eye check-up (if it’s a part of your test package)
9.If you are on any medication, then we request you to carry the
medicines or its prescription along with you at the time of medical
checkup and inform the co-coordinator.
10.Kindly carry reports of the previous investigations,
consultation notes or medications (for significant illness if any) as
it will facilitate a better evaluation of the medical history.
11.Pap smear & Urine test cannot be carried out for females during
their menstrual period.*
12.Please inform in writing if you are pregnant before going for
Customer Care :
8045574102
Email :
healthcheckup@vitalstep.in
Date
:
Employee Signature
:
Customer Care :
8045574102
Email :
healthcheckup@vitalstep.in