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Age Estimation - Proforma

This document is a form for the examination and certification of age through physical, dental, and radiological assessments. It includes sections for personal information, examination details, and the doctor's opinion on the individual's age. The form requires signatures and identification marks to validate the findings.

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Bharath reddy Bana
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574 views2 pages

Age Estimation - Proforma

This document is a form for the examination and certification of age through physical, dental, and radiological assessments. It includes sections for personal information, examination details, and the doctor's opinion on the individual's age. The form requires signatures and identification marks to validate the findings.

Uploaded by

Bharath reddy Bana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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FORM FOR EXAMINATION AND CERTIFICATION OF AGE

(Physical Dental & Radiological Examination)

Date
Time
MLC No

1. Name
2. S/0./D/0./W/0 :
3. Age as stated by :
4. Address
5. Brought by
6. Referred by
7 History(Reason for examination):
8. Consent:
9. Identification Marks:
a.
b.

10. PHYSICAL EXAMINATION:

Hair-Moustache: Axillary: Pubic

External Genitalia

Development of breast: Menarche:

11. DENTAL EXAMINATION:


Total number of teeth=
Dental formula (modified FDI)

AGE CERTIFICATE:

From Physical and Dental/Radiological Examination of


Mr./ Mrs./ Ms
bearing the identification marks
1)
2)

I am of opinion that the individual is aged between yrs. and yrs.

Signature

Name of the doctor


Date: Designation with seal

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