I ( )\l ll)l \ ll\i

REPORT OF MEDICAL EXAMINATION OF SEAFARER BY AN APPROVED MEDICAL EXAMINER

As per Merchant Shipping (Medical Eramination) Rules 2000. STCW conv 1978 (Code 1/3). ILO 147 & MLC Convenlion 2006 as amended

GL'-a,BUS
Dr. Diwakar Tiwari Dr. Sameer Paaate
IA65, OG3 rn.tr! Ao9..v.d KE.PJ.g*AH xsas'ocsl,ni.^Fd.d
NAME: NANDA RAN]AN KUMAR AGE/SEX 56 Yrs/ lt{ale SERTAL No: GP2309241
(Sum.oe. Fid Nft, Lird. tlftl
OOB| 15-11-1967 PP I COC ?lo.t Z1 467 441 RANK: MASTER. INDOS No: 01N11
VESSEL: TYPE: ROUTE:
HOttE AODRESS: DHARITRI APTS FLAI NO 9 PLOT NO 7 SEC'11 SKM MARG NEW PANVEL 41O206
COMPANY IATIE: Walkin ILO / DG Shippinq
COMPANY ADDRESS

Med ical Historv: Candidat€ Examiner'g Med ical Historv: Candidat€ Examine/s
Please fill to the best of your knowHge Pleas€ fll to lh€ besl of your lnowl€dge
ls there any pastor present history of lhe following ls Olere any past or pres€nt history of the lollowing
Severe one-sided headacie Oral / Dental/ Tooth disorder
Head lniury / Cond6sion / Loss of Memory Hemia / Hydroco€le / Appendicitis
Fits / Epilogsy / Dizziness / Fainlng High / Low blood prossure / Heart disease
Eye / Vsion Problems ( Glasses etc ) Aslhama / Bronchitis / Tubercllosis
Heainq lmpairm€nt Allergy / Skin disease
Ear / Nos€ / Throat Problerfi lnfection / Contagirus dis€ase
Stomach / Bowel disorders Addiction to alcoM / dtugs / tobacco
Gall Stones I Kadney disorders Fraclure / Oislocation / lnjury / Amputatron
Jaundico / Liver Disease Major / Mino. Operalion
Piles / Vancoso veins Diabetes
Blood Disorder Nervous / Mental diseas€ / Sleep disoder
Signed off on Medi.al grounds / D€dared Unft Malignanl Disease (Cance4
Not€s:H/O: Sx hydro.oele done in 1997. Glasses for near vision. BMI 32.83

Heighl (cm) weiqht (Kgs) BMI(ks/m2) Chest lnslExp(cm) Blood Pressu.e in mm ol Hg Pulse-8eats/min Resp. Rate / min General Condition
159 8l 32.81 r05- 100 r20 88 / 80 18 GOOD

Dislanl Vision Uncoffected Corrected H€aring

Right Eye 6t6 Raqht Ear 7 meters 5 meters
Lefl Eye 6t6 Left Ear 7 meters 5 meters

Colour lshihara No.mal / Audiometrykhz 500 1000 2000 3000 4000 6000

Olher N;;;i7 Riqht Ear dB 2D 25 10 15 25 t0

Field of Yision NORMAL Left Ear dB 15 15 15 25 10 15

c Nomal @ Noles
Respiratory System
Normal
II
Head & Neck
Cadlovascular System
Eyes
Ear/Nose/Throat FIT FOR SEA SERVICE I
Teeth / Oral Cavity
Musculo - Skeletal Syslem
As MASTER.
Genito - Urinary system
Olhers I
Nervous System
Reflexes
AS PER MLC 2006 Hemia / Hydrocoele
Varicose veins
-
Skin Fis$relFistula/Piles
lnvestigations
Tests Ref. Tosls Resuh T€sls Result
I.iEMOGLOAIN 13.2 12-0 - la,O grnra HASAG
7800 a{II).o - 1160o ellrd.mm NEGATN€ SONOGRAPIIY

ilillHlllffi
WBC COUNT
R8C COL]NI NEGATIvE ECG
NEUTROPHIT 55 40.0 - 75.0 % URINE COLOUR DRUGS O' AAUSE NEGAiVE
LYMPIIOCYTE 2o.0 -,15 0 % 1015
EOSINOP}iIL !! 1o-60 URINE PH ACTOTC atooo GRo!JP
PLATELETS 1730@ 1 50000.0 - :15!000.0 /crn ABSENI
ESR

S G.P,T
18
112 --l 80.0 - 140.0 h!/dL
1 0 - 40 0lu/L
BIIE SALTS
gILE PIGMENT
OCCULT SLOOD
ABSENT
AASENT
AESENT
GGT 21 0.0-a5.0u/! Rac cEtLs AASENT
s cHor r5.0-2600mS/d

r
14,6

CREAIININE PIIS CELLS(URINE)

URIi{E VOIUME
23 hpf
30
,..../ \: k- I--

w
DRIG{Nr
I
._l T

r.al tnn. Itcture taken dudnq

medlcals on 23'0+2024

On lhe bssis ol6ramin€6's histfiy, dinical oradna&r and diagnoslic l€sts. l, Dr. Kumar Rahul h€Eby dodere h6 eramin€e medaally

F'tl / Unft Tempordnly Unfit Pemlanently lJnfil Should be re-examined alter days^rreeks/months
R.m..t., R.cdrln rd.Uon FIT for sea service as MASTER.
This Coalficat 16 valld tlll 22'09-2025
lv-
Officlll St np Signrture
"r"oro*'.?"frU- GLOBUS SAKSHAT
s&hehrr{9.nE.raail]!A
o f Ku a a Ra h u I
tlD- OnB R.9. l{o. ]6195
Sfi turPIbI-l ld-n-na.tn ocs Appo!.d BHR/Pllrrl6iilo2,r t :2|l*2O24
 Annexure -lV
Medical Certificate for Service at Sea
Issued under the Authority of Directorate 6eneral of Shipping, Govt. of lndia under Rule 4 of M.S.
(Medical Examination) Rules, 2fit0 as amendedl

NANDA RANJAN KUMAR

(Seafarer's Name; l-ast, First, Middle)
I
LSlLuL967 Male l.
Date of Eirth: (ddlmm/yyyy) Gender: (Male/Female)

PP No. 27467417 CDC NO. BY7O149 IN DIAN

(Number of : CDc/Passport/other valid identification document ) (Nationality)

has been examined by : Dr. Kumar Rahul - BHR/PTN/16/2o24

(Name of Medical Examiner and approval no.)

and has been found fitA if,t' for the service al sea in the job of MASTER.

(a) The hearing and sight of the sea farer concemed, and the colour vision in the c€se of a seafarer
to be emplo)red in capacities where fitness for the work to be performed is liable to be aftected by
defective colour vision, are all satisfactory, and

(b) The seafarer concemed is not suffering from any medical condition likely to be aggravated by
Services at Sea or to render the seafarer unfit for such seNice or to endanger the heatth of other
persons on board.

(c)The seafarer complies with the requirements specified in Table A-l/9 of STCW Code (i.e Minimum
in service eyesight standards for seafarer).Table B-l/9 of the STCW Code (i.e Assessment of
minimum entry level and in service physical abilities for seafarers) Regulation I .2, sbndard A-1.2 &
Guidelines B-1 .2 of the Maritime Labour Convention 2006

23 O24 Patna lndia )*

(Date & Place of Medical Examination)
(signature of
*l-r" +re tredical Examiner)

Globus saksham
Saksham lmaging and Diagnostic
Center, L82B;SK Puri, Patna-80O1
PHt o224L2O687 4ns
EMAILT medlcaldlrector@globusmedicare.com
GP2309241
(Serial number of the certificate) (Address with Email lO & Contact No. of the
Medical Examiner)

Dr. Kumar Rahul

MD. DNB Reg. No.36795
22t09t2025 DGS Approved BHR/PrN1612024
This Certificate expires on'
OD/MM/YYYY (official Stamp of the Medical Examiner)

(,Not more than 2 years from the date of issue, unless the seafarer is under lhe age of 18, in which case
the maximum period of validity of the Medical Certificate shall be 1 year.)

lf the period of validity of the medical certificate expires in the course of voyage,then the medical certificate
shall conEnue to be in force for a period not exceeding three months from the date of expiry, or unitil the next
port of call where an approved Medical Examiner is available, and the seafarer can get examined and obtain
renewed medical certificate from that Medical Examiner
 Annexure -V

SIGHT TEST CERTIFICATE

New Entry'/Periodict

Reference No. GP2309241

Full Name RAI{JAN KUMAR NANDA

Rank MASTER.

PP/COC/lD No. 27467 447 E.

Date and place of birth L5iltL967 NALANDA

Colour of eyes ELACK

ldentification Notes MOLE ON CHEST

Riqht Eye Left Eye Both Eye Result

Unaided 616 6t6 6/5 NORMAL
Distance Vision
Aided NA NA NA NA
Unaided N-t2 N-12 N-8 NA
Near Vision
Aided it -8 N-8 N-6 NORMAL
Horizontal Plane Adequate Adequate Adequate NORMAL
Field Of Vision
Vertical Plane Adeouate Adequate Adequate NORMAL
lshihara NORMAL NORMAL
Colour Vision NA
Lantem/others NA

l, Dr. Kumar Rahul hereby certiry that the above mentioned candidate has meuf,€t-rn€t+ the eye sight
standards for his/hor designated ranupositio n as set out in Annex-ll'/Annex{ll' for seafari ng occupatlon.

A/""
ru
Candidate's Signature (s of Medical Examiner)
Dr. Kumar Rahul
Daled 2310912lJ24 at Patna
MD, DNB Reg. No. 36795
DGS Approved BHR/PTN/16i2024

Globus saksham

saksham lmaging and Diagnostic

Center, 1828, sK Puri, Patna'8oo1
PH:61245O2191

Note
1)This certiticate is valid for two years trom the above date. New entry sight test certificates should be retained
by the candidate till his active sea career.

2)Seatarer aggrieved by the decision of the Medical Examiner may appeal as per the provision ol the M.s-
(Medical Examination) Rules, 2000 as amended.
 I{umbai : No.3-8, Shubham Center ll, Chakala, Andheri(E), Mumbai- 400 099. Ph : 022 - 41206874f5

GLtrd)BUS Yalsed:RoyNursirEHomeandICCU,NanaParsrwad.Valsad,Gujaral-396001.Ph:0263-2319314
Chennai : Standard Healthcare, #46, VGP Rajesh Nag6r, Pallikaranai, Chennai{oo 100. Ph : 044 - 49571046

MEDICARE
Nt lso 2015 C.ttifed
Prtna : Saksham lmaging and Diagnostb Center, 1 828, SK Pud. Patna- 800 001 . Ptr-
Email : admin@globusmedicare.com I www.globusmedicare.com
061 2 - 45021 91

MEDICAL CONDITION DECLARATION

Name : RANrat{ KUMAR t{a]{DA Datc : 23-O9-2024
Date Of Birth : 1s-11-1967
Gender : Male
Passport Number '.2146744, CDC No. :8Y7o149
Rank : MASTER.
Company & Addrcss : watkin tLo / DG shlpping

I, the undersigned, hereby declare that:-

I am NOT suffering from a:ry medical or psychiaric condition and NOT under any medication.
OR
I am suffering fiom
Below is the list of medicine that I shall be carrying with me for entire voyage plus 2 months :-
l.)
2.')

3.)
4.)
5.)

I understand the importance oftimely medication and to follow the advise given by the doctor.
I hereby declare that I will not be carrying any drugs/medicine on board apart from that as listed above (ifany).
The above list of drugs (ifany) have been approved by the Company recognized Doctors at Globus Medicare.

I understand that failure to declare my medical conditions, previous treatment history, history of medical sign off
or carrying any undeclared medicine on board will result in cancellation of cover by P&l insurance for any untoward
medical condition resulting on-board. I also understand that my Organisation (employer) will not be responsible to bear
expenses of my medical treatment or repatriation charges arising due to false declaration ofabove.

I will not hold the organisation or the medical center responsible for any untoward event occuring on-board
S4 Dr. Kumar Rahul
MD, DllB Reg. t10.36795
)
W.-- o
PATNA
i P Seal
DGS Approved BHRiPTN/16/2024

& Signature of Physician

Signatue of the candidate

DG Shipping & OGUK Approved P&l Clubs and Flag State Approved
Pathology o ECG o X Ray o USG o Stress TesUTMT oAudiometry o Spirometry
GLfi4BUS fumbai : No.3{, Shubham Center ll, Chaiala, Andheri{E), Mumbai- 4m 099.Ph .022- 41mffi74n5
Vabad:RoyNuGingHomeandICCU,NanaParsiwad,Valsad,Gujarat-396001.Ph:0263-2319314
Chennai : Standard Healthcare, #"46, VGP Rajesh Naga( Pallikaranai, Chennai{o0 100. Ph : ()14 - 49571046

MEDICARE lso N1 2015 c.ttified

Patna:SakshamlmagingandoiagnosticCenler,lS2B,SKPuri,Palna-800001.Ph-0612-4502191
Email : admin@globusmedicare.com I wrvw.globusmedicare.com

sr- o: GP2309241 Date:23-09-2024

ame: RANJAN KUMAR NANDA Age / Sex 56 / Male

Reference: Walkin lLo / DG ShipPing

AUDIOM REPORT

-20
+ Right Ear
-10 + Left Ear
0
10

20
co
! 30

E 40
o, 50
J
o!
,E 60
(o
CJ 70
I
80
90
100
r10
120
250 500 lk 2k 3k 4k 6k 8k
Frequency in Hertz (Hz)

I
)
o
PATNA
Dr. Kumar Rahul
P
REMARKS:
ilD, OttB Reg, t{o. 36795

DGS Approwd BHR/PTl,lll6/2024

BILATERAL HEARING SEI{SITIVTTY WITHIN I{ORMAL LIMITS

DG Shipping & OGUK Approved .. P&l Clubs and Flag State Approved
Pathology o ECG o X Ray o USG o Stress TesVTMT oAudiometry o Spirometry
 Xumhi : No. 3-8, Shublram Center ll, Chakala, Andheri (E), Mumbai - 400 0€9. Ph : 022 - 412ffi874l/5

GLfid)BUS lhbad:RoyNursingHorneandICCU,NanaParsivrad,Valsad,Gujarat-396001.Ph:0263.2319314
Chcnnai : Standard Healtrcare, fl46, VGP Ralesh Nagar, Pallikaranai, Chennai400 100. Ph : M - 49571M6

MEDICARE $0nU 1U5 Cefiied

Paha : Saksham lmaging and Diagnodic Center, 1828, SK Puri, Paha 800 m1. Ph

Email : admin@globusmedicare.om l',vr,vw.globusmedicare.com

061 2 - 4502191

sr.No.: GP2309241 Oalei 23 I Og I 2024

Nam'; RANJAN KUI\,iAR NANDA AgGrSer 56 / Male

RsferEnce: walkin ILO / DG Shipping

URINE DRUG AND ALCOHOL ASSAY

TEST RESULT U]IITS REF.RANGE

AMPHETAMINES NEGATME ng/ml Less than 1000n9/ml

BARBTTURATES NEGATIVE ng/ml Less than 3oongy'ml

CANNABINOIDS (MARIJUANA) NEGATIVE ng/ml Less than song/ml

COCAINE NEGATME ng/ml Less than 3oongy'ml

oP|ATES (MORPHINE) NEGATIVE ng/ml Less than 3oongy'ml

BENZOOIAZEPINE NEGATIVE ng/ml Less than 300n9/ml

ALCOHOL(GGT) 21.o u/L 0.{5 U/L

Kindly Corelate clinically

Method : Qualitative lmmunochromatographic assay.
Nole :
Cut-off value is based on the reclmmendalion ot NIDA (National lnstifirte of Drug Abuso).

A positive test result indicates only the pressnca of durg metabolites above the cid off values and does not mgasure intoxication .

The resutt obtained sele as an aide to diagnosis and should be interpreted in relation to food habits, medicine intake etc-

A single urine test cannot differentiate casual us€ from chronic drug abuse. Sequential testing is recommended to conlim drug abuse.

The detection time in urine or blood is extemely variable and depends on factors such as type of drug ingested, dose and duration of its

usage

GGT or Gamma Glutamyltransferaso is most widely used biomarker for alcohol abuse. GGT is an enzyrne which is
normally present in
every human being in the range of 0.4S truL. GGT tevels of more than 49 UUL is suggeslive ofalcoholabuss and needs confirmation by
other tesls

xx E D OF REPORT xx

tl* P
Dr re€ty Saha Dr, Kumar Rahul
J
M0. Reg N0.40355
f0. 0il0 Reg. lo. 36195
o
PATNA
oGS llFovrd NRIPII{/1fl 202l

'L=LOw,'H=HIGH

DG Shipping & OGUK AP proved ,r P&l Clubs and Flag State Approved
Pathology o ECG o X Ray o USG . Stress TesUTMT. Audiometry Spirometry '
 tumbi : No, $8, Shubham Center ll, Chakala, Andhui(E), Mumbai- 400 0S.Ph .0U - 412ffi74ns

GLfi4BUS Valsad:Royl'lursingHomeandICCU,l',lanaParsirvad,Valsad,Gujarat-3S001.Ph:0263-2319314
Chsnnai : Standard Heathcare, #46, VGP Raiesh Nagar, Pallikaranai, Chennai{oo 100. Ph : 044 - 4957'1Mo

MEDICARE 150 9N1 2015 Ccttilied

Paha : Saksham lmagirB and Diagnostic Center, 1828, SX Puri, Patna- 8t10 001. Ph- 0612 - 4m2191

Email : admin@globusmedicare.mm I www.globusmedieare.com

Sr.No.: GP2309241 Oate'.23lOgl2024

l{am.: RANJAN KUMAR NANDA Agerser 56 / Male

Reference: walkin ILO / DG Shipping

X.RAY CHEST PA VIEW

Both lung fields show equal translucency and vasculature.

Pleural spaces are clear.
Both hila appear normal.
The cardiac size is normal.
The domes of diaphragm are normal in position & show smooth outline.
The bony parts are normal.

IMPRESSION
No significant abnormality is seen

Report with thanks,

P
Dr. Kumar Rahul
t0.0[B Reg. ilo. $n5
mS Aflro{rd 8tlft?Tll/1ti2fr2{

DG Shipping & OGUK Approved o P&l Clubs and Flag State Approved
Pathology o ECG o X Ray e USG . Stress TesUTMT. Audiometry. Spirometry
 Iumhi : No. !8, Shubham Center ll, Chakala, tudheri (E), Mumbai- 400 0€9. Ph : 02 - 41206874fl5

GLfi )BUS Valsd:RoyNuningHomeandICCU,NanaParsiwd,Valsad,Gujarat-396001.Ph:0263-2319314

Cheflnai : Standard itealthcare, #46, VGP Ralesh Nagar, Pallikaranai, Chennai{00 100. Ph : 044 - 49571016

MEDICARE 150 9N1 2015 C2fif$d

PatE:SakshamhEgmgandDiagmsbCenter,lS2B,SKPuri,PatpS00ml.Ph-0612-4502191
Email : admin@globusmedicare.com I www.globusmedicare.mm

Sr.t{o.: GP2309241 Oalei 23 I Og I 2924

Nsme: RANJAN KUMAR NANDA Age/Sor 56 / Male

Reference: Walkin ILO / DG Shipping

ULTRASOUND OF ABDOTIEI{ & PELVIS

Liver is normal in siz€ shows homogenous parondrytnal echogenicity. No tocal mass l€sions seen. lntra & extrahepatic biliary & portal radides
are normal. Portalvein is nonnal at porta hepatis

Gall Bladd€r is physhally well dislsnded. lts wall is nomal. No e,/o inFaluminal sludge or cahulus. CBD is normal

pancreas is nomal in size slro,ving normal echogenicity. No focal mass lesion. Splenic vein at hilum is normal

The Spleen is normal in size. There is no focal lesion. The splfiic vsin is noirnal.

Both Kidnoys are normat in sizs shape, axis, cor our A edrogenicity. No e/o focal solid or cystic mass lesion. No a/o cakulus o. hydroneph@sis.
CentIal sinus echo complox b no,mal. Both Kidnoys move rvellwith respiration.

There is no ascit€s or signifcant adenopathy

Thorc is no evidence ot bowel loop thidening or dilatation

urinary bladder is wBll distended. lts wafl $id(1oss is nomal. No abnomal intraluminal e€ioes or calqrlus.

Prostats is normal in size and ecfiogericity. No focal mass lesion.

UPEESSIOU
No significant abnormality noted

Advl!.
Kindly corelate dinically.

Report with thanks,

P
0r. Kumar Rahul
I'tI),0tl8 Reg. tlo, $795

oGS AMoved EHRlPTil/16/2024

DG Shipping & OGUK Approved o P&l Clubs and Flag State Approved
ology o ECG o X Ray. USG r Stress TestrTMT rAudiometry. Spirometry
tN I t Rf ,1r roN \r. cER I r lrrf ,r r Es ol. \1\( cr N.\ r roNs oH F[ R\O\ rl 1ll. rl l H lll\I(lnl t('.nriouc.l)
R]:\r((r\\rtoN \c rrNs I C OI.TiRA
KUMAR NANDA nIEDIC.TIIONS IANEN ltE(;t LARL'l (c.g inrulin. digirBlis)
Tlti\
Male D.te of Blnh iledic.ti(nrr pri( reglllier€m(llt (e.8,i suline. digitrlc)
\ lmr. iian
llrc follo$r
llr1 on th( drrc inlist.rl hf?d t!c<irrled or r.r.cci..lcrl rtrintl

Stsmhr., ADprEv.d
D.le Prof..rlod Sltaur r
.ddrltr olvr..irdor

23-O9-2024 Ol'll I ll.\l.nll( lIfol{\l1Tl(r\ (pr(*riplion i:l,rr$,

r t rhrrron oph!.nhx(lr.

I I II
V.lidit! Dit.

(rl,)
sdi.r
II
\D Oc.Lr

\
Dr. Kumar Ra 1ul
MD. DNB R€9. No. 36; 95
DGS Approved 8HR/PTNI 6t202t \dd Bet{. (rnr
Orh.r
Globus Sak3ham -
saksham lmaglng and Dlagnostic C.nt.r, 1828' sK
Purl, Prtna-8OOl

oTHtR rMNtrl\tz\ l loNs/ l,llofH\ L.\\ls R€cElYEl) tNTt t{\tTl()N^l- ( l,ll{l ll l( \l l:s ()l
\ r( ( t\ \l t()\s
(immune globulin, mtlari., mtatlet et<-)

propBLcdc drrg Slgnriurr .\s ,\lPR()\ El) llY

I lti \1()RLl) lll,:\l.l H ORC{l\ls,\TloNs
I L\CLP T I:0RADDRLSS0I \ AC('INAToR)

CLRI IFI('{I ES I\ I ER\AI IO]\ I \ DE

\ 1( ('l\ \ l l()\
\PPROI. \ [S PTR

| , oRc.\\rs{r lo\ l\Io\l)l \1,}. l)l Lls\\TE

(SAT I,L. \DDRLSSL\ t)L] \'AC( I\\TLt R)

tll tk's N1\ll1-\()\l l)t \(rl \cll(rl{

RANiAII AR NAT{DA
\r)llrrf\\- \l]rll \\l r\l \llll lt.\l \lt llar r\fl{l I l.lll f)
DI.iAiiITRi APTS FLAT NO 9 PLOT NO 7
SEC-11 SKM MARG NEW PANVEL 410205
(CITI'-VILLE)

((ol \Tttl-t)l r'\lrT\luliT) ETA)

INDIAiI na

fi"Xil Globus Medicare

-'/ ( tso9u, :2ots )
 SEAFARER'S CONSENT TO ALCOHOL AND DRUG SCREENING

To,
GLOBUS SAKSHAM
Saksham lmaging and Diagnostic Center,
'1828, SK Puri, Patna.

Dear Sir,
I the undersigned, hereby confirm that I have no history of drug abuse or alcohol abuse or smuggling of any
illegal substances.

lalso confirm that have not been convicted ofany criminal offence, drug related or oherwise.

I fully understand the penalties relating to the sub.iect of illegal drugs / drugs of abuse and will assist the
appropriale authority / authodties wherever and whenever possible.

I hereby accept unconditionally any unannounced testing policy / policies for alcohol and illegal drugs / drugs of
abuse with clauses that may be incorporated / implemented by Chartere6 / Oil-Companies with guidelines laid
down by Oil Companies lntemational Forum (OCMIF)

ln last week have you consumed any of the below drugs ?

Yes No Yes No

I II
I
Cough Syrup L/' Corticosteroids \.,-
Pain Killers, lf yes, please state the Anti-Epileptics V
name of drug, Crocin/AspiriniBrufen
etc.

Sleeping Tablets (Sedatives)

I
\./ Nasal Decongsstants

Any other medicine from family doclor

II 1.,.

lf answer to any of lhe above is Yes, Please provide details below :

To what extent do you consume

Alcohol No ni
Tobacco (Chewing / Smoking) , No rJi
Drugs :
4orlE

Name QarL(prt kumn{ ^lAi.JM -,2?>-

Rank nD<7€€ AD-;<(,N
Z)tr L)/rd)
sMITCH OF
Passport No ( JI )
\.gzy
ut 08us )
CDC No b\-t;yrr^1fn
>4 /1r1
Vessel Name f47 a STVthUo \"{Iq
Signature !,A.*a.rt
Date o-z/oi lzn'zQ
 GLOBUS SAKSHATA
PATNA

Paticnt: RAIIJIN Krl{AR Age 56 Yrs G€n&! i ldalc

@
NANDA
FGf,d. By : Iteight 160 6,3 sDok€! i No
Pred.Eqns: RECORDERS weight 86 xg3 EtI!. Corr: 100
Date . 23-09-2021 05:20 PH ID 38 Ieq I

F (Lj.Lres/sec )
FVC*P!.d Int !p!.t tiorl
16 PEvl tP!.d COPD SEVERIAY
+ 150 150
L4 oBs NORII L25 oEs rrotu
L25

t2 100 100

15 15
I'ODER:ATE
10
50 50
I PI.: }'R
25 25
vERY TE RES MI)@D RES
6 0 0
oFEF50 * 2 50 75 100 125 150 25 50 75 100125150
4 (EEYI/i'!rc) tPr.d (?Enlnc) tP!.d
Evc Resulta
2 OFEF] 5I tPrcd tlq)
v (Li-tres) Ptrlmetcr Pred l{. PtG tPrad N.Pott
0
4 :)
F,trC (L) 02.73 02.t2 0?8
FE\'1 (L) 02. 09 01.68 080
Egrtr-/Evc (t) ?6.56 79.25 104
-4
EEF25-?5 lll sl 03.03 01.t5 048
PEFR lll.) 3t_T
06. 68
:::
H (L) oL .72
-6 5 (L) 01.35
-8 FEV3 (L) 02-64 02.05 0?8
PIER ILI EI 01 {0
EEF75-85 (UB) _:: _- 00 38
-L0
Litres FEF.2-1.2|L/81 0s. 29 o2 89 055
25* lll r) o7.2L 0{ .53 0 6il
rEr 50t lll El 0{.88 01 .95 0,lO
't FEF 7s* (Ll8l 01. 92 00 .53 028
FElr.5/nC (t) 6a.15
6 FCV3/EVC (t) 96. 70 96.70 100
EET (sec) 0{.72
Ii.Eo (Sec) 00.02
5 lga (Yr!) ;;;-- 067 120
E'EV5 (L) 02.73
4 FIF25* (Ll8) 00.03
FIFsot (Ll s\ 0r. . 33
3 s.- (Dlp) 01.16
Test cithin nolrnal li-trlits
) EFEVl

0
1234 557 I
1(seconds)
A^'-
Doctor'a Noces
Prc U.dication RcPort IndicaLaa SPilo4try flithia f,ot al Lfuni ta
s Dr. Ku ar Rahul
A MD, DNB Reg. No.'36 795
AE
J DGS Approved BHR/PTN,1 02024
o
* Kumar Rahul
UD DNB
b'lot"'v cli'tctl //rn-@indl..cd O AxS +fr-.t.r (H.lio!-w].2.621
'rh. cont.!t3 ol tnl. t.polt r.g!it..lr'ic.l ce..Iation
'cllon
lD: 47854 23-09-2024 03:51:58 AM
RANJAN KI]MAR NANDA TIR :61 bpm Diagnosis Information:
Male 56Ycars P :99 ms Sinus Rhythm
Req. No. :7654 PR : 149 ms rttNormal ECGrtr s
QRS :90 ms
QT/QTcBz : 388t392 ms o
PiQRS/T
RV5/SVl
:
:
l6t27tzl
0.84410.619 mV l^-
Report f,onf irmed by:
*
rNA *

Dr. Kumar Rahul

MD, tlt{B Reg. t{o..3679{,
I

II

III

aVR

aVL

aVF

II

r O.67-rcOHz AC50 25mm/s l0mmrmV 2'5.0s+lr V2.21 SEMIP V1.92 SAKSHAM IMAGING AND DIAGNOSTIC CENTRE