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Medical

This document is a medical leave application for a student at GLA University, Mathura, requesting a 75% attendance condonment due to illness. The student, Aditn Ashuyla, has been diagnosed with viral conjunctivitis and has attached supporting medical documents. The application must be submitted within one week after recovery and does not guarantee leave approval.

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skshukla1371944
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159 views3 pages

Medical

This document is a medical leave application for a student at GLA University, Mathura, requesting a 75% attendance condonment due to illness. The student, Aditn Ashuyla, has been diagnosed with viral conjunctivitis and has attached supporting medical documents. The application must be submitted within one week after recovery and does not guarantee leave approval.

Uploaded by

skshukla1371944
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GLA University, Mathura

Medical Leave Application fr Condonment of 75%, Attendence


*Fill oll the entriey in capitol letters only.

Name: ADITN ASHUYLA University Roll No.:


21550003>
Father's Name: PANKAJ SHUrLA Father's Contact No.:
Programme: B.TELH Year: a83A4o1228
Branch: CSE CAML) Section:
Type of ilness:
Duration of illness:
VIRAL CaNTUNETI VITIS CBOTH EE)
Hospitalized (Yes/No) 26|wNo
|24 to 04||24. Total Days:
(Submit supporting
documents)
Name of the Doctor:
ASHUTOSH AGARLINL
Pathology Report
Radiology
Reports Attached: Prescription Please tick on the documents submitted
Medical Certificate
Any Other
Signature of Student: Contact No:
92194067 0
Date:

924
Signature &Name of
Signature &Name of CA Year Co-ordinator Signature & Name of HOD

Approved

Director

Note: 1, Submission of this application does not guarantee sanction of


leave.
2. Medical Leave for less than four working days shall not be
granted.
3, The application is likely to be rejected if it is not submitted within one week
after the fitness.
Ph. 0522-3293464
9415025213

doce
ifsC-21, A47-4, Arse taet E, ia,au 24

Rais..2.6.0.24..

Dr Ashutos1Agarwal
MJe. BS. MS
Eye Surceon
nshAgarwal P NR40970
Srs eon
RNO.-040970
Agarwal Medical Centre
(An advanced centre for Infertility. Maternity &Eye Care)
Hospital 7385, Opp SL Mary's Inter College, Noar Bhlthiauli Crossing, Jankipuram Extn Lucknow
Clinlc C-21, Sector'P, Near Soctor'a'Chauraha,Aliganj,Lucknow,Phone:9415025213
Dr. Ashutosh Agarwal Dr. Sarika Agarwal
MBBS,, oGO
MBB S. M.S. (Ophth)
KGMC Lucknow CONSULTANT OBSTETRICIAN, GYNAECOLOGIST
CONSULTANT EYE SURGEON &INFERTILITY SPECIALIST
Reg. Na 040970 Rog No.040971
Vvekana Pölyclinc
Sewa Honpitat EConsutart Eras, Lucknow MedicalColege
Timing 10 00 a m o 1130 a.T Tnlng 10.008.1 10 01 30pT NHosia
Hospital 05.00 pm 1o 0730p.m
500 . mio 06.30 pm Jankipuram Extr Sünday:10,00am toD1.30Dm tankipuram Extn
Sunday 1000 8n o l0 30 a m
Sunday Evening Ciosad Sunday EvningClosed

06.30 p.m. to 09 00 pmAigan Clinc


Sunday I100a m, to 0100 p.m
Sunday Evening Closed
Eye Care:
Dala261024
Coniact Leng Satvs Nama
Wond Bes SovEREICN Paca
Mechine (Sichess Calaact Sgery)
Douiar sasound (Eomedix USAJ:

Pesi Cphthamolgy
Cornta Evalaon &Managanent
Retnz Evaaions Manaqeent
Orbogc Exetcises Wih Sytaptopbara
ND YAG LAsAr

Mother Care

Pas ring hu prescnpionSDays on tuture v


Ths pescriplion s Vakd for
This prekGtipton dose not ho any lega abilty
Shop
Surgery, Pharmacy &Optical Ultrasound.
24 Hrs.Emergency, Admissions,
Doppler Ultrasound, Trans Vaginal, Mammography &Ocular
Colour

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