Medical Form

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Name *
Class
Date of Birth
Admission No.
Sex
Father's Name
Mother's Name
Address
Telephone No.
Mobile No.
Specific disease suffered in the past
Surgery undergone in the past
Any disease for which the child is on regular medication and details of medication
Allergies, if any (Materials)
Allergies, if any (Food/Drinks)
Allergies, if any (Medicines)
Name of the Immunization











Any regular medicine, the dose of which is to be given in the school,(please enclose prescription of the treating physicaian)
(.jpg or .pdf format)
Emergency medication which the child needs to be given(please enclose prescription of the treating physician)
(.jpg or .pdf format)
Name and contact number of the family doctor & person to be contacted in case of emergency
7949

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