KRISHNA KUMAR ORTHOPAEDIC HOSPITAL
& INSTITUTE OF ORTHOPAEDICS PVT. LTD.
Overbridge, Parvathipuram, Nagercoil - 629 003, K.K. Dist.
EMPLOYEE HEALTH CARD
Name:
Age/Sex:
Department:
Designation:
Op No.:
Blood Group:
Precmployment Wt.
Checkup
Date
Ht. BMI BP
History
:
O/E
:
Diagnosis
:
Treatment
: Inj. T. Toxoid
Urine
Urine
Alb Sugar Micro
D.O.J.
Emp.No.
CBC ESR Chest HbsAg HIV Signature of
Staff entering
X-ray
Results with
Emp. No.
Worms Treatment:
Any other No.
Dr. Signature with seal/Rgn.
1st dose date:
HBsAg
Immunisation Signature:
2nd dose date:
3rd dose date:
Booster dose date:
Signature:
Signature:
Signature:
Post Employment Checkups Annual & In case of Interventions:
Date
Wt.
BMI
BP
Details of Diseases, Test Results & Treatment
Signature
KKOH/HR/GEN/16