doe issued format for affidavit of medical certificate needed at time of delhi nursery admission for session 2013-14

doe issued format for affidavit of medical certificate needed at time of delhi nursery admission for session 2013-14

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                                           Format Of Affidavit For Medical Certificates


MEDICAL HISTORY OF THE CHILD [Form 2.1]

I, __________________ father/mother of ___________________ student of Class/Sec.________ Admission No.________ hereby confirm that my child/ward is suffering/not suffering from:
? Allergy to any food item/drug.
? Fits
? Bronchial Asthma/Bronchospasm
? Any other disease for which the child is on regular medication.

Parents to note that concealing correct medical history may result in expulsion from hostel immediately.

Date : _______________ Signature of Parent

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                                       MEDICAL FITNESS CERTIFICATE [Form 2.2]
(To be signed by a Regd. Medical Practitioner)

Certified that Master/Miss ____________________________ Son/Daughter of _____________________________
? is medically fit.
? has no allergy.
? has not suffered from any Acute/Chronic disease which needs constant Medical Supervision (if yes please specify).

Date : ________________ Signature of Medical Officer

Name with Regn. No. & Seal _______________________

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                                                IMMUNISATION CERTIFICATE [Form 2.3]
To be certified by an Registered Immunisation Centre or copy of vaccination card can also be attached

Certified that Master/Miss ____________________________ has been immunised against

1. Typhoid Vaccine on dated ____________________ (Injection/Oral Caps)
2. Injection against Hepatitis B
Ist dose on dated _____________________
2nd dose on dated _____________________
3rd dose on dated _____________________
3. Hepatitis A 1st Dose on _____________ 2nd Dose on ___________________
4. Chicken Pox ________________ (No vaccination required if suffered earlier)

Date : ________________ Signature of Medical Officer

Name with Regn. No. & Seal _______________________

19-Mar-2015 09:37:22 IST

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