This document is a health status form for MBA students from the 2020-2022 batch. It collects information such as the student's name, contact details, medical condition, details of their consulting doctor, current medications, and any emergency procedures or support needed from the institute. The form is signed by the student and includes a section for office remarks.
This document is a health status form for MBA students from the 2020-2022 batch. It collects information such as the student's name, contact details, medical condition, details of their consulting doctor, current medications, and any emergency procedures or support needed from the institute. The form is signed by the student and includes a section for office remarks.
This document is a health status form for MBA students from the 2020-2022 batch. It collects information such as the student's name, contact details, medical condition, details of their consulting doctor, current medications, and any emergency procedures or support needed from the institute. The form is signed by the student and includes a section for office remarks.
This document is a health status form for MBA students from the 2020-2022 batch. It collects information such as the student's name, contact details, medical condition, details of their consulting doctor, current medications, and any emergency procedures or support needed from the institute. The form is signed by the student and includes a section for office remarks.
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Annexure 10
HEALTH STATUS FORM
MBA Batch 2020-22 1. CAT Reg. No. : _____________________________________________ 2. Name of the student : _____________________________________________ 3. Contact Number of Student : _____________________________________________ 4. Mother’s Name : _____________________________________________ 5. Father’s Name : _____________________________________________ 6. Contact Number of Mother/ Father : _____________________________________________ 7. Description of Medical Condition : _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ 8. Name and details of consulting doctor : _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ 9. Current prescribed medication : _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ 10. Does the condition presents with any : _____________________________________________ emergency scenario? If yes, details _____________________________________________ thereof and suggest measures to be _____________________________________________ taken at that time _____________________________________________ ____________________________________________ 11. Any support expected from : _____________________________________________ the Institute to overcome the challenges _____________________________________________ faced due to such medical condition (Signature of the student, with date)